Exploration of risk factors of platelet transfusion refractoriness and its impact on the prognosis of hematopoietic stem cell transplantation: a retrospective study of patients with hematological diseases

Plain Language Summary What is the context? Platelet transfusion refractoriness is a critical issue, and it greatly increases bleeding risks and hospitalization costs. Patients with hematological diseases tend to develop PTR. PTR results from immune and nonimmune factors and the latter account for 80-90%. At present, there are few studies focused on the inducing factors of PTR, and the specific mechanism is not clear. What is new? In this study, we investigated 108 patients with hematological disorders who received allogeneic HSCT from January 2019 to December 2020. We found that splenomegaly and JAK gene mutation were independent risk factors for PTR in patients with hematological diseases. PTR had a passive effect on the prognosis of patients after HSCT, as indicated by worse OS and a trend toward lower platelets after transplantation. PTR might affect megakaryocyte reconstitution after transplantation. What is the impact? This study provides evidence that hematological patients with splenomegaly should be alert to the occurrence of PTR, which often indicates a worse prognosis of transplantation. Spleen reduction and JAK inhibitors in the treatment of PTR are worth exploring. Platelet transfusion refractoriness (PTR) is an intractable issue in hematological patients, which increases bleeding risks and hospitalization costs to a great extent. We reviewed 108 patients with hematological diseases including acute leukemia, myelodysplastic syndrome, aplastic anemia, and others who received allogeneic hematopoietic stem cell transplantation (HSCT) from January 2019 through December 2020. After multivariable logistic regression, we found that splenomegaly (odds ratio [OR] = 26.98, p < .001) and JAK mutation (OR = 17.32, p = .024) were independent risk factors for PTR. During the period of transplantation, patients in the PTR group had a significantly higher platelet transfusion demand, which was reflected in the increased number of platelet transfusions (10.23 & PLUSMN; 6.696 vs. 5.06 & PLUSMN; 1.904, p < .001). After multivariate adjustment, PTR turned out to be independently associated with worse overall survival (hazard ratio = 2.794, 95% confidence interval = 1.083-7.207, p = .034). In conclusion, we found that splenomegaly and JAK gene mutation were independent risk factors for PTR in patients with hematological diseases. A history of PTR prior to allo-HSCT indicates a poor prognosis.