Consolidation Therapy Is Associated with Significantly Lower Bleeding Risk Compared to Induction Therapy in Patients with Acute Myeloid Leukemia

Background: Between 2005 und 2010 we conducted a multicenter randomized study comparing a therapeutic and a prophylactic (morning platelet (ptl) trigger < 10/nl) platelet transfusion strategy in patients with hematological disorders. (The Lancet Vol 380, No 9850, pp 1309-16). Briefly, we could show that a therapeutic plt transfusion strategy, where platelets are transfused in clinical stable patients (pts) only if bleeding ≥ WHO grade II occurs is safe in patients after autologous transplantation. In patients with acute myeloid leukemia (AML) we observed significantly more severe bleedings (WHO IV°) with the therapeutic regimen. To proof, if there is a difference in bleeding risk related to the remission status of the patients, we conducted a post-hoc analysis to compare the risk of severe bleeding (WHO III° and IV°) in induction with consolidation therapy.

Patients and Methods: We analyzed 175 pts with 175 cycles of induction therapy, 90 with a prophylactic transfusion regimen and 85 cycles with a therapeutic regimen. 131 pts received 268 cycles of consolidation therapy, 155 with a prophylactic and 113 with a therapeutic transfusion strategy.

Results: Bleedings WHO III° were neither different between the two strategies nor between induction and consolidation therapy. In contrast, there were significantly more bleedings WHO IV° in induction (7,4%) compared to consolidation therapy (1,5%; p=0,01). In addition, there were significantly more bleedings WHO IV° with the therapeutic regimen (11,8%) compared to the prophylactic strategy (3,3%) in induction therapy (p=0,012). This difference was less pronounced in consolidation therapy. But even in the prophylactic arm most WHO IV° bleedings occurred in pts with more than 10/nl ptl, which shows, that the morning platelet count should not be the only trigger for a platelet transfusion.

Conclusions: In consolidation therapy the risk of bleeding is significantly less compared to induction therapy, even with a therapeutic platelet transfusion strategy. During induction therapy the prophylactic strategy should remain the standard of care. The therapeutic transfusion strategy in consolidation therapy will be proven prospectively in an ongoing multicenter study.