Stem Cells, Vol 12, 370-377, Copyright © 1994 by AlphaMed Press
Platelet support and the use of cytokines
JF Bishop
Department of Haematology and Medical Oncology, Peter MacCallum Cancer Institute, Melbourne, Australia.
Severe thrombocytopenia and clinical bleeding remain major clinical
problems in leukemic patients undergoing remission induction and those
receiving high dose chemotherapy. Prophylactic platelet transfusions have
made a major impact on hemorrhagic deaths over the last 20 years. The
effectiveness of platelet transfusions is influenced by a number of
clinical factors including the status of the spleen, prior bone marrow
transplantation, the presence of disseminated intravascular coagulation and
the presence of HLA antibodies. Optimal platelet transfusion therapy
requires that transfusions be monitored routinely by post- transfusion
counts and that a refractory group be clearly defined. The cytokine
granulocyte colony stimulating factor (G-CSF) has not had a clinically
significant impact on thrombocytopenia. Granulocyte- macrophage colony
stimulating factor (GM-CSF) also probably has little clinical relevance,
although in a randomized study, thrombocytopenia was worse in
GM-CSF-treated patients. Interleukin-3 (IL-3) can increase platelet count
and has the potential to protect against thrombocytopenia in patients
receiving chemotherapy. This hypothesis is currently being tested in
on-going clinical trials.
