Data Sheet 1_Personalized management of platelet transfusion refractoriness: risk factors, cross-matching, and IVIG strategies.pdf

Logistic regression identified factors associated with antibody development. The primary analysis was performed using linear mixed-effects models (LMMs) with a random intercept for patients to account for within-patient correlation. Fixed effects included transfusion strategy along with prespecified episode-level and patient-level covariates.

Generalized estimating equations (GEE) were used as a sensitivity analysis to assess the robustness of the findings.</p>Results<p>Female sex emerged as the strongest independent predictor for the development of platelet antibodies (OR: 4.18, 95% CI: 2.25–8.24). Other univariate risk factors included age, obstetric history, diagnosis, and chemotherapy cycles. Among antibody-positive patients, both cross-matched platelets and IVIG combined with random platelets were associated with improved 24 h CCI compared with random platelets alone (all p_Holm < 0.001), cross-matched platelets were associated with higher 24 h CCI relative to random plus IVIG (p_Holm = 0.019), whereas cross-matched platelets plus IVIG demonstrated no additional benefit vs. cross-matched platelets alone in this cohort (p_Holm = 0.444).

In antibody-negative patients, no statistically significant difference in 24 h CCI was observed across the four transfusion strategies (p = 0.244). Consistent with the LMM results, the overall effect of transfusion strategy was not statistically significant among antibody-negative patients (p = 0.692) but was significant among antibody-positive patients (p < 0.001). Similar results were obtained using GEE, supporting the robustness of these findings.</p>Conclusion<p>Among patients with antibody-negative PTR, cross-matched platelets and IVIG demonstrated no additional benefit in this cohort.

For antibody-positive PTR, cross-matched platelets showed the most favorable response in this cohort; when unavailable, high-dose IVIG with random platelets may be preferentially considered. These comparative treatment findings require prospective validation.</p>