Use of platelet transfusions and tranexamic acid in patients with myelodysplastic syndromes: A clinical practice survey

Aim: Thrombocytopenia and bleeding are common in myelodysplastic syndromes (MDS), but optimal management is unknown. We conducted a survey to identify current clinical practice regarding platelet transfusion (PLT-T) and tranexamic acid (TXA) to inform future trial design.Method: A 25-question survey was distributed to members of the ALLG from December 2020 to July 2021.Results: Sixty-four clinicians across Australia, New Zealand and Singapore responded. Clinicians treated a median of 15 MDS patients annually. Twenty-nine (45%) reported having institutional guidelines regarding prophylactic PLT-T. Although 60 (94%) said they would consider using TXA, most (58/64; 91%) did not have institutional guidelines. Clinical scenarios showed prophylactic PLT-T was more likely administered for patients on disease-modifying therapy (49/64; 76%, commonest threshold <10 x 10(9)/L) or with minor bleeding (32/64 [50%] transfusing at threshold <20 x 10(9)/L, 23/64 [35%] at <10 x 10(9)/L). For stable untreated patients, 29/64 (45%) would not give PLT-T and 32/64 (50%) would. Most respondents (46/64; 72%) were interested in participating in trials in this area. Potential barriers included resource limitations, funding and patient/clinician acceptance.Conclusion: Real-world management of MDS-related thrombocytopenia varies and there is a need for clinical trials to inform practice.