Desborough, M., Estcourt, L.J., Doree, C., Trivella, M., Hopewell, S., Stanworth, S.J., & Murphy, M.F. (2016). Alternatives, and adjuncts, to prophylactic platelet transfusion for people with haematological malignancies undergoing intensive chemotherapy or stem cell transplantation. Cochrane Database of Systematic Reviews, 8, CD010982.

DOI Link

Purpose

STUDY PURPOSE: To evaluate the safety and effectiveness of adjunctive or alternative agents to platelet transfusions in patients with hematologic malignancies undergoing intensive chemotherapy or stem cell transplantation to prevent bleeding

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PubMed, ClinicalTrials.gov, WHO, ICTRP, ISRCTN
 
INCLUSION CRITERIA: Randomized, controlled trials in which patients with hematologic malignancies undergoing intensive chemotherapy or stem cell transplantation were allocated to either platelet transfusion alternatives or to a comparator
 
EXCLUSION CRITERIA: Studies involving antifibrinolytic agents were excluded.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 7,313 references were initially retrieved. After removing of duplicate studies, and those not meeting criteria, 14 papers reporting on 16 trials were reviewed. Ten trials were included in this review, because six trials were ongoing at time of publication.
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Data extraction was conducted according to the guidelines established by the Cochrane Handbook for Systematic Reviews of Interventions. Abstracts and citations were reviewed by two authors, and two authors evaluated the data for risk of bias.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 10 trials
  • TOTAL PATIENTS INCLUDED IN REVIEW = 554
  • SAMPLE RANGE ACROSS STUDIES: Sample size ranged from 18 to 120.
  • KEY SAMPLE CHARACTERISTICS: Six trials (n = 336) included patients with acute myeloid leukemia (AML) receiving intensive chemotherapy; two trials (n = 38) included patients with lymphoma undergoing chemotherapy; two trials (n = 180) included participants undergoing allogeneic stem cell transplantation. In nine trials, a thrombopoetin (TPO) mimetic was compared to placebo or standard of care; in one trial, platelet-poor plasma was compared to platelet transfusion. All trials were conducted in high-income countries, and were equally well represented by men and women.

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

The authors concluded that the available evidence does not allow a determination of the effect of TPO or platelet-poor plasma on the prevention of bleeding in patients with hematologic malignancies undergoing intensive chemotherapy or stem cell transplantation. This conclusion is attributed to the quality of evidence (very low quality) and the lack of adequate power to detect a clinically significant decrease in bleeding. No trials identified which evaluated agents, such as artificial platelet substitutes, fibrinogen concentrate, recombinant activated factor VII, or desmopressin, in this population.

Conclusions

Sufficient, high quality evidence does not exist with which to determine the safety or efficacy of adjunctive or alternative agents to platelet transfusions in patients with hematologic malignancies undergoing intensive chemotherapy or stem cell transplantation in the prevention of bleeding.

Limitations

  • Mostly low quality/high risk of bias studies
  • Low sample sizes
  • Studies were underpowered to detect a clinically significant difference in bleeding; in addition, eight trials were funded by the manufacturer of the agent being studied.

Nursing Implications

Additional studies are needed to evaluate adjunctive or alternative agents in the prevention of bleeding. Neither TPO nor plasma-poor platelets can be substituted for platelet transfusions given the current state of knowledge.

Legacy ID

6344