Stem Cells, Vol 13, 588-596, Copyright © 1995 by AlphaMed Press
Platelet transfusion and alternatives to transfusion in patients with malignancy
L Vaickus, JB Breitmeyer, RL Schlossman and KC Anderson
Serono Laboratories, Inc., Norwell, Massachusetts 02061, USA.
Platelet transfusions have long had an important role in the treatment of
patients with thrombocytopenia due to disease or myelotoxic treatment or in
patients with reduced platelet function. However, platelet transfusions are
associated with numerous risks, both immunologic (e.g., transfusion
reactions, alloimmunization, immunosuppression) and infectious (e.g.,
viral, bacterial). In addition, several laboratory and clinical factors can
influence post- transfusion platelet recovery. Recent technological
advances have introduced the potential for using alternatives to platelet
transfusions, such as cytokines or platelet substitutes, which may avoid
the risks of transfusion. Platelet development from megakaryocytes is a
process that is highly regulated by cytokines and animal research suggests
that selected cytokines involved in this process may be useful in the
treatment of thrombocytopenia. Newer developments, including the
utilization of recombinant cytokines with relatively selective stimulation
of platelet production (e.g., interleukin 6 [IL-6]) and the recent
discovery of a megakaryocyte colony stimulating factor (thrombopoietin),
represent major therapeutic opportunities in the treatment of
thrombocytopenia. Platelet substitutes, e.g., thromboerythrocytes, also
show promise in the management of platelet deficiencies.
