Potential Clinical Applications of Thrombopoietic Growth Factors

Abstract

Patients receiving intensive chemotherapy or marrow-ablative regimens as treatment for a variety of cancers require repetitive transfusions of platelets. Although death from hemorrhage is a rare event in such patients, minor episodes of bleeding are common, and there are appreciable potential complications from repeated platelet transfusions (Table 1). The most clinically ominous of these side effects is the development of alloimmunization with the requirement for identification and apheresis of histocompatible donors. Often, such compatible donors cannot be readily located, and the patient remains at risk of bleeding. Another serious problem is the frequent occurrence of febrile or allergic transfusion reactions, even in patients premedicated with antipyretics and/or antihistamines; these reactions can be quite discomfiting and frightening for the patient. In neutropenic patients, such transfusion reactions often mandate hospitalization and interim coverage with broad-spectrum antibiotics until culture results are available. Although transfusion reactions are common in alloimmunized patients, the presence in the plasma of a variety of different cytokines, elaborated because of damage to contaminating leukocytes during storage, is responsible for the frequent development of transfusion reactions in nonalloimmunized recipients (1).