The Efficacy of Therapeutic Thrombocytapheresis in Patients with Thrombocytosis

Abstract

Objectives: Therapeutic thrombocytapheresis (TTA), also known as platelet depletion, is used for rapid cytoreduction in symptomatic patients or prophylaxis of high-risk patients with extreme thrombocytosis. In this paper, we present our center’s nearly 20-year experience with TTA. Materials and Methods: The medical registry of Ankara University Faculty of Medicine Therapeutic Apheresis Unit was retrospectively reviewed for TTA procedures between January 1999 and December 2020. Results: One hundred and ninety-six TTA procedures were applied to 90 patients, including 46 (51.1%) males and 44 (48.9%) females. The median age was 52.5 years (18-83). Seventy-four (82.2%) patients with essential thrombocytosis, 5 (5.6%) with chronic myeloid leukemia, 5 (5.6%) with primary myelofibrosis, 3 (3.3%) with thrombosis in acute phase and 3 (3.3%) with others were treated. 61 (67.8%) patients had initial platelet count as <1,500x109/L, 29 (32.2%) patients ≥1,500x109/L. The median initial platelet count was 1,230x109/L (545-3,825x109/L). Thirty-three (36.7%) patients required >1 TTA procedures. The decrease of platelet count was 571.5x109/L (72-3,128x109/L) and 47.5% (6.2-92.4). After TTA, the PLT count was ≤450x109/L in 19 (21.1%) patients, 450-1,000x109/L in 56 (62.2%) patients, and≥1,000 x109/L in 15 (16.7%) patients. The patients were divided into two groups according to initial platelet count. The decrease in platelet count was significantly higher in the group with PLT ≥1,500x109/L[477x109/L (72-1,644) vs 1,142x109/L (363-3,128), respectively, p=0.001]. The rate of reduction was similar [46.1% (6.2-92.4) vs 50.9% (18.3-89.2), respectively, p=0.097]. Conclusion: TTA can provide rapid reduction of platelet count and is suitable for patients with acute serious thrombotic or hemorrhagic events or high-risk patients with very high platelet counts.

Keywords

• Therapeutic Thrombocytapheresis
• Thrombocytosis
• Cytoreduction

Trombositozlu Olgularda Terapötik Trombosit Aferezinin Etkinliği

Abstract

Amaç: Trombosit azaltılması olarak da bilinen terapötik trombosit aferezi (TTA), semptomatik hastalarda veya aşırı trombositozlu yüksek riskli hastaların profilaksisinde hızlı sitoredüksiyon için kullanılabilir. Bu yazıda, merkezimizin yaklaşık 20 yıllık TTA deneyimini sunuyoruz. Gereç ve Yöntem: Ocak 1999 - Aralık 2020 tarihleri arasında yapılan TTA işlemleri için Ankara Üniversitesi Tıp Fakültesi Terapötik Aferez Ünitesi tıbbi kayıtları retrospektif olarak incelendi. Bulgular: Kırk altı (%51,1) erkek, 44 (%48,9) kadın olmak üzere 90 hastaya toplam 196 TTA işlemi yapıldı. Ortanca yaş 52,5 yıl (18-83 yıl) olarak saptandı. Yetmiş dört (%82,2) hasta esansiyel trombositoz (ET), 5 (%5,6) hasta kronik miyeloid lösemi (KML), 5 (%5,6) hasta primer miyelofibrozis (PMF), 3 (%3,3) hasta akut fazda yaygın tromboz ve 3 (%3,3) hasta diğer tanılarla işleme alındı. Altmış bir (%67,8) hastanın başlangıç trombosit sayısı <1.500x109/L, 29 (%32,2) hastanın ≥1.500x109/L ve ortanca başlangıç trombosit sayısı 1.230x109/L (545-3.825x109/L) olarak bulundu. Otuz üç (%36,7) hasta >1 TTA işlemine ihtiyaç duydu. TTA ile trombosit sayısı ortanca 571,5x109/L (72-3.128x109/L) ve %47,5 (%6,2-%92,4) azaltıldı. TTA prosedürleri sonucunda 19 (%21,1) hastada ≤450x109/L, 56 (%62,2) hastada 450-1.000x109/L, 15 (%16,7) hastada ≥1.000x109/L PLT sayısı elde edildi. Hastalar başlangıç trombosit sayılarına göre PLT <1.500x109/L ve PLT≥1.500x109/L olarak iki gruba ayrıldı. Trombosit sayısındaki azalma PLT ≥1.500x109/L olan grupta anlamlı olarak daha yüksek bulunurken [sırasıyla; 477x109/L (72-1.644) ve 1.142x109/L (363-3.128), p=0,001], trombosit sayısının azalma oranı benzer bulundu [sırasıyla; %46,1 (6,2-92,4) ve %50,9 (18,3-89,2), p=0,097]. Sonuç: TTA trombosit sayısının hızlı bir şekilde azaltılmasını sağlamaktadır ve akut ciddi trombo-hemorajik komplikasyonlu hastalar veya çok yüksek trombosit sayısı olan yüksek riskli hastalar için uygundur.

Keywords

• Trapötik Trombosit Aferezi
• Trombositoz
• Sitoredüksiyon

References

1. 1. Schafer AI. Thrombocytosis and thrombocythemia. Blood Rev. 2001;15:159- 166.
2. 2. Preston FE. Essential thrombocythaemia. Lancet. 1982;1:1021.
3. 3. Hehlmann R, Jahn M, Baumann B, et al. Essential thrombocythemia. Clinical characteristics and course of 61 cases. Cancer. 1988;61:2487-2496.
4. 4. Robbins G, Barnard DL. Thrombocytosis and microthrombocytosis: a clinical evaluation of 372 cases. Acta Haematol. 1983;70:175-182.
5. 5. Padmanabhan A, Connelly-Smith L, Aqui N, et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher. 2019;34:171-354.
6. 6. Almeida-Dias R, Garrote M, Cid J, et al. Therapeutic thrombocytapheresis for extreme thrombocytosis after chemotherapy in essential thrombocytosis. J Clin Apher. 2019;34:503-506.
7. 7. Sugawara A, Ebina K, Ohi H, et al. Chronic subdural hematoma associated with primary thrombocythemia; report of an operated case, using plateletpheresis. No Shinkei Geka. 1991;19:851-855.
8. 8. Debureaux PE, Brignier A, Soret-Dulphy J, et al. Thrombocytapheresis and sequential chemotherapy for extreme symptomatic thrombocytosis secondary to myelofibrosis: a case report. Ann Hematol. 2020;99:897-898.

9. 9. Boddu P, Falchi L, Hosing C, et al. The role of thrombocytapheresis in the contemporary management of hyperthrombocytosis in myeloproliferative neoplasms: A case-based review. Leuk Res. 2017;58:14-22.
10. 10. Prakash S, Hans R, Sharma RR, et al. Therapeutic Thrombocytapheresis for Symptomatic Thrombocytosis in Hemato-Oncology Patients. Ther Apher Dial. 2018;22:93-95. 11. Małachowski R, Grzybowska-Izydorczyk O, Besson N, et al. Safety and feasibility of therapeutic platelet depletion with Spectra Optia in a pregnantwoman. Transfus Apher Sci. 2017;56:563-565.
11. 12. Das SS, Bhattacharya S, Sen S. Managing uncontrolled postsplenectomy reactive thrombocytosis in idiopathic thrombocytopenic purpura: role of thrombocytapheresis. Transfus Apher Sci. 2013;49:171-173.
12. 13. Raval JS, Redner RL, Kiss JE. Plateletpheresis for postsplenectomy rebound thrombocytosis in a patient with chronic immune thrombocytopenic purpura on romiplostim. J Clin Apher. 2013;28:321-324.
13. 14. Yilmaz M, Dikmen T, Sonmez M, et al. Change of coagulation parameters after double plateletpheresis. Transfus Apher Sci. 2007;37:161-163.
14. 15. Siti Nadiah AK, Nor Asiah M, Nur Syimah AT, et al. Effects of plateletpheresis on blood coagulation parameters in healthy donors at National Blood Centre, Kuala Lumpur, Malaysia. Transfus Apher Sci. 2013;49:507-510 . 16. Falchi L, Bose P, Newberry KJ, et al. Approach to patients with essential thrombocythaemia and very high platelet counts: what is the evidence for treatment? Br J Haematol. 2017;176:352-364.
15. 17. Carobbio A, Thiele J, Passamonti F, et al. Risk factors for arterial and venous thrombosis in WHO-defined essential thrombocythemia: an international study of 891 patients. Blood. 2011;117:5857-5879.
16. 18. Tefferi A, Fonseca R, Pereira DL, et al. A long-term retrospective study of young women with essential thrombocythemia. Mayo Clin Proc. 2001;76:22-28.
17. 19. Budde U, Schaefer G, Mueller N, et al. Acquired von Willebrand’s disease in the myeloproliferative syndrome. Blood. 1984;64:981-985.
18. 20. Finazzi G, Carobbio A, Thiele J, et al. Incidence and risk factors for bleeding in 1104 patients with essential thrombocythemia or prefibrotic myelofibrosis diagnosed according to the 2008 WHO criteria. Leukemia. 2012;26:716-719.
19. 21. Weiss DR, Dankerl H, Martin A, et al. Von Willebrand factor multimer structure is neither acutely nor chronically affected by plateletpheresis. Clin Lab. 2014;60:1207-1212.
20. 22. Barbui T, Barosi G, Birgegard G, et al. Philadelphia-negative classical myeloproliferative neoplasms: critical concepts and management recommendations from European LeukemiaNet. J Clin Oncol. 2011;29:761-770.