Thrombotic and hemorrhagic complications in children and young adult recipients of Hematopoietic Stem Cell Transplant (HSCT)

Dominder Kaur, Aneel Arjun Ashrani, Rajiv Pruthi, Shakila P. Khan, Kent R Bailey, Vilmarie Rodriguez

Research output: Contribution to journalArticle

Abstract

Background: Overall incidence of hemostatic complications in pediatric recipients of Hematopoietic Stem Cell Transplant (HSCT) is scarcely studied. This retrospective review explored the incidence and underlying risk factors of bleeding and thrombotic complications in children. Procedure: Clinical characteristics, hemorrhagic events (HE), thrombotic events (TE) and follow up data were abstracted from medical records on patients aged <21 years undergoing HSCT during January 2000–June 2015. Results: From start of conditioning until last follow up, 238 pediatric patients were reviewed during this study. There were 16 symptomatic thrombotic complications in 15 patients, along with 13 major bleeding events. Incidence of HE or TE was higher in allogeneic HSCT compared to autologous HSCT (p = 0.02). Severe thrombocytopenia could not be identified as a major contributor to bleeding. All patients with HE had platelets between 20,000–50,000 × 109/L, except one patient, who had platelets <20,000 × 109/L. All patients with hemorrhagic cystitis (n = 7) had received cyclophosphamide (Cy). For patients with sinusoidal obstruction syndrome, conditioning included either busulfan (Bu)/Cy (n = 5), Cy with total body irradiation (n = 4), or thiotepa (n = 2). Among allogeneic HSCT recipients, 56% of HE and 82% with TE had underlying myeloid neoplasms. Graft versus Host disease contributed to both types of complications (p = 0.07), although not reaching statistical significance. Conclusions: Allogeneic pediatric HSCT patients had higher overall risk of hemorrhagic or thrombotic complications compared to autologous recipients in this study. HSCT for myeloid malignancies was a risk factor for higher complications.

Original languageEnglish (US)
Pages (from-to)44-49
Number of pages6
JournalThrombosis Research
Volume167
DOIs
StatePublished - Jul 1 2018

Fingerprint

Hematopoietic Stem Cells
Young Adult
Transplants
Cyclophosphamide
Pediatrics
Hemorrhage
Incidence
Blood Platelets
Hepatic Veno-Occlusive Disease
Thiotepa
Busulfan
Cystitis
Whole-Body Irradiation
Graft vs Host Disease
Hemostatics
Thrombocytopenia
Medical Records
Neoplasms

Keywords

  • Bleeding
  • Children
  • Clotting
  • Complications
  • Hematopoietic stem cell transplant (HSCT)
  • Hemorrhage
  • Thrombosis
  • Venous Thromboembolism (VTE)

ASJC Scopus subject areas

  • Hematology

Cite this

Thrombotic and hemorrhagic complications in children and young adult recipients of Hematopoietic Stem Cell Transplant (HSCT). / Kaur, Dominder; Ashrani, Aneel Arjun; Pruthi, Rajiv; Khan, Shakila P.; Bailey, Kent R; Rodriguez, Vilmarie.

In: Thrombosis Research, Vol. 167, 01.07.2018, p. 44-49.

Research output: Contribution to journalArticle

@article{46672d66af0541f0b16192cbf027c508,
title = "Thrombotic and hemorrhagic complications in children and young adult recipients of Hematopoietic Stem Cell Transplant (HSCT)",
abstract = "Background: Overall incidence of hemostatic complications in pediatric recipients of Hematopoietic Stem Cell Transplant (HSCT) is scarcely studied. This retrospective review explored the incidence and underlying risk factors of bleeding and thrombotic complications in children. Procedure: Clinical characteristics, hemorrhagic events (HE), thrombotic events (TE) and follow up data were abstracted from medical records on patients aged <21 years undergoing HSCT during January 2000–June 2015. Results: From start of conditioning until last follow up, 238 pediatric patients were reviewed during this study. There were 16 symptomatic thrombotic complications in 15 patients, along with 13 major bleeding events. Incidence of HE or TE was higher in allogeneic HSCT compared to autologous HSCT (p = 0.02). Severe thrombocytopenia could not be identified as a major contributor to bleeding. All patients with HE had platelets between 20,000–50,000 × 109/L, except one patient, who had platelets <20,000 × 109/L. All patients with hemorrhagic cystitis (n = 7) had received cyclophosphamide (Cy). For patients with sinusoidal obstruction syndrome, conditioning included either busulfan (Bu)/Cy (n = 5), Cy with total body irradiation (n = 4), or thiotepa (n = 2). Among allogeneic HSCT recipients, 56{\%} of HE and 82{\%} with TE had underlying myeloid neoplasms. Graft versus Host disease contributed to both types of complications (p = 0.07), although not reaching statistical significance. Conclusions: Allogeneic pediatric HSCT patients had higher overall risk of hemorrhagic or thrombotic complications compared to autologous recipients in this study. HSCT for myeloid malignancies was a risk factor for higher complications.",
keywords = "Bleeding, Children, Clotting, Complications, Hematopoietic stem cell transplant (HSCT), Hemorrhage, Thrombosis, Venous Thromboembolism (VTE)",
author = "Dominder Kaur and Ashrani, {Aneel Arjun} and Rajiv Pruthi and Khan, {Shakila P.} and Bailey, {Kent R} and Vilmarie Rodriguez",
year = "2018",
month = "7",
day = "1",
doi = "10.1016/j.thromres.2018.04.023",
language = "English (US)",
volume = "167",
pages = "44--49",
journal = "Thrombosis Research",
issn = "0049-3848",
publisher = "Elsevier Limited",

}

TY - JOUR

T1 - Thrombotic and hemorrhagic complications in children and young adult recipients of Hematopoietic Stem Cell Transplant (HSCT)

AU - Kaur, Dominder

AU - Ashrani, Aneel Arjun

AU - Pruthi, Rajiv

AU - Khan, Shakila P.

AU - Bailey, Kent R

AU - Rodriguez, Vilmarie

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background: Overall incidence of hemostatic complications in pediatric recipients of Hematopoietic Stem Cell Transplant (HSCT) is scarcely studied. This retrospective review explored the incidence and underlying risk factors of bleeding and thrombotic complications in children. Procedure: Clinical characteristics, hemorrhagic events (HE), thrombotic events (TE) and follow up data were abstracted from medical records on patients aged <21 years undergoing HSCT during January 2000–June 2015. Results: From start of conditioning until last follow up, 238 pediatric patients were reviewed during this study. There were 16 symptomatic thrombotic complications in 15 patients, along with 13 major bleeding events. Incidence of HE or TE was higher in allogeneic HSCT compared to autologous HSCT (p = 0.02). Severe thrombocytopenia could not be identified as a major contributor to bleeding. All patients with HE had platelets between 20,000–50,000 × 109/L, except one patient, who had platelets <20,000 × 109/L. All patients with hemorrhagic cystitis (n = 7) had received cyclophosphamide (Cy). For patients with sinusoidal obstruction syndrome, conditioning included either busulfan (Bu)/Cy (n = 5), Cy with total body irradiation (n = 4), or thiotepa (n = 2). Among allogeneic HSCT recipients, 56% of HE and 82% with TE had underlying myeloid neoplasms. Graft versus Host disease contributed to both types of complications (p = 0.07), although not reaching statistical significance. Conclusions: Allogeneic pediatric HSCT patients had higher overall risk of hemorrhagic or thrombotic complications compared to autologous recipients in this study. HSCT for myeloid malignancies was a risk factor for higher complications.

AB - Background: Overall incidence of hemostatic complications in pediatric recipients of Hematopoietic Stem Cell Transplant (HSCT) is scarcely studied. This retrospective review explored the incidence and underlying risk factors of bleeding and thrombotic complications in children. Procedure: Clinical characteristics, hemorrhagic events (HE), thrombotic events (TE) and follow up data were abstracted from medical records on patients aged <21 years undergoing HSCT during January 2000–June 2015. Results: From start of conditioning until last follow up, 238 pediatric patients were reviewed during this study. There were 16 symptomatic thrombotic complications in 15 patients, along with 13 major bleeding events. Incidence of HE or TE was higher in allogeneic HSCT compared to autologous HSCT (p = 0.02). Severe thrombocytopenia could not be identified as a major contributor to bleeding. All patients with HE had platelets between 20,000–50,000 × 109/L, except one patient, who had platelets <20,000 × 109/L. All patients with hemorrhagic cystitis (n = 7) had received cyclophosphamide (Cy). For patients with sinusoidal obstruction syndrome, conditioning included either busulfan (Bu)/Cy (n = 5), Cy with total body irradiation (n = 4), or thiotepa (n = 2). Among allogeneic HSCT recipients, 56% of HE and 82% with TE had underlying myeloid neoplasms. Graft versus Host disease contributed to both types of complications (p = 0.07), although not reaching statistical significance. Conclusions: Allogeneic pediatric HSCT patients had higher overall risk of hemorrhagic or thrombotic complications compared to autologous recipients in this study. HSCT for myeloid malignancies was a risk factor for higher complications.

KW - Bleeding

KW - Children

KW - Clotting

KW - Complications

KW - Hematopoietic stem cell transplant (HSCT)

KW - Hemorrhage

KW - Thrombosis

KW - Venous Thromboembolism (VTE)

UR - http://www.scopus.com/inward/record.url?scp=85047221001&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047221001&partnerID=8YFLogxK

U2 - 10.1016/j.thromres.2018.04.023

DO - 10.1016/j.thromres.2018.04.023

M3 - Article

C2 - 29787942

AN - SCOPUS:85047221001

VL - 167

SP - 44

EP - 49

JO - Thrombosis Research

JF - Thrombosis Research

SN - 0049-3848

ER -