Disparities in the consensus for treatment of chemotherapy-induced thrombocytopenia

Abstract

Introduction: Chemotherapy-induced thrombocytopenia (CIT) is an arduous complication of chemotherapy to be dealt with, and there are many unmet needs in this field to be addressed on the global front. We have conducted this study to contribute to the understanding of existing knowledge gaps of CIT management and highlight the direction to focus future investigations.

Methods: This was an academic single-institution report on a cross-sectional study evaluating CIT management practices using platelet (PLT) transfusions by haematologists and oncologists in Armenia.

Results: Physicians' opinions differed significantly when it came to defining thrombocytopenia by PLT levels. 13.2% of those surveyed considered thrombocytopenia to be when PLT counts fall below 180 × 10⁹/L, 42.1% defined thrombocytopenia to have a PLT threshold of 150 × 10⁹/L, 15.8% and 21.0% specialists setting their thresholds at 140 × 10⁹/L and 100 × 10⁹/L, respectively.All physicians managed CIT by performing PLT transfusions for prophylactic purposes (i.e., when PLT count falls below a certain threshold) with none of them transfusing PLTs only on-demand to address active bleeding. 73.3% haematologists (adult), 57.1% medical oncologists, and 50% paediatricians deemed 10 × 10⁹/L as the threshold PLT count for transfusing afebrile patients with haematologic malignancies (besides acute promyelocytic leukaemia (APL)) and solid tumours.PLT products availability varied among the respondents, with only 53% of them responding that they had 24/7 access.

Conclusion: CIT is a complication of interest to physicians worldwide and has not been resolved yet. This is the first conducted survey regarding CIT and the initial step for further research.

Keywords: chemotherapy; guidelines; platelets; thrombocytopenia.

Figure 1.. (a): According to NCI criteria there are 4 grades of thrombocytopenia based on PLT thresholds: 75 to <100 × 10⁹/L (Grade 1), 50 to <75 × 10⁹/L (Grade 2), 25 to <50 × 10⁹/L (Grade 3); <25 × 10⁹/L (Grade 4). However, only 21.0% of our respondents defined thrombocytopenia to have a PLT threshold of 100,000/mcL, while the majority (42.1%) denoted a threshold of 150,000/mcL. Also 15.8% and 13.2% of those surveyed considered thrombocytopenia to be when PLT counts fall below 140,000/mcL and 180,000/mcL, respectively. A threshold of 130,000/mcL was mentioned by 2.6% of the specialists. (b): All physicians preferred PLT transfusions for prophylactic purposes (not only on demand). Afebrile patients (non-APL) would be transfused when having PLT count below 10,000/mcL by 60.5% of physicians whereas 36.8% and 2.6% of specialists performed transfusions when PLT counts fell below 20,000/mcL and 50,000/mcL, respectively.