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Incidence, Cost, and Outcomes of Bleeding and Chemotherapy Dose Modification Among Solid Tumor Patients With Chemotherapy-Induced Thrombocytopenia

From the Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX.

Address reprint requests to Linda S. Elting, DrPH, Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 40, Houston, TX 77030; email: lelting{at}mdanderson.org

PURPOSE: To describe the incidence and outcomes of bleeding and chemotherapy dose modifications associated with chemotherapy-induced thrombocytopenia (platelets < 50,000/µL).

PATIENTS AND METHODS: Six hundred nine patients with solid tumors or lymphoma were followed-up during 1,262 chemotherapy cycles complicated by thrombocytopenia for development of bleeding, delay or dose reduction of the subsequent cycle, survival, and resource utilization. The association between survival and bleeding or dose modification was examined using the Cox proportional hazards model. Predisposing factors were identified by logistic regression.

RESULTS: Bleeding occurred during 9% of cycles among patients with previous bleeding episodes (P < .0001), baseline platelets less than 75,000/µL (P < .0001), bone marrow metastases (P = .001), poor performance status (P = .03), and cisplatin, carboplatin, carmustine or lomustine administration (P = .0002). Major bleeding episodes resulted in shorter survival and higher resource utilization (P < .0001). Chemotherapy delays occurred during 6% of cycles among patients with more than five previous cycles (P = .003), radiotherapy (P = .03), and disseminated disease (P = .04). They experienced similar clinical outcomes but used significantly more resources. Dose reductions occurred during 15% of cycles but were not associated with poor clinical outcomes or excess resource utilization. Significantly shorter survival and higher resource utilization were observed among the 20% of patients who failed to achieve an adequate response to platelet transfusion.

CONCLUSION: The incidence of bleeding is low among solid tumor patients overall but exceeds 20% in some subgroups. These subgroups are easily identifiable using routinely available clinical information. A clinical prediction rule is being developed. Poor response to platelet transfusion is a clinically and financially significant downstream effect of thrombocytopenia and warrants further investigation.

Presented in part at the Thirty-Third Annual Meeting of the American Society of Clinical Oncology, May 17-20, 1997, Denver, CO.

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