Suppression of Hematopoietic Primitive Cells in Patients with secondary failure of platelet recovery after acute graft-versus-host disease
Suppression of Hematopoietic Primitive Cells in Patients with secondary failure of platelet recovery after acute graft-versus-host disease
复制标题
急性移植物抗宿主病后继发血小板恢复失败患者的造血原始细胞抑制
DOI：
10.1016/j.bbmt.2020.06.003
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Jianmin Wang
中科院分区：
文献类型：
--
作者：
Ajijie Huang;Xiaoming Zhao;Meizhang Li;Gusheng Tang;Yang Fei;Roujia Wang;Lei Gao;Xiong Ni;Weiping Zhang;Jianmin Yang;Xiaoxia Hu;Jianmin Wang
Secondary failure of platelet recovery (SFPR) can occur after allogeneic hematopoietic stem cell transplantation (alloHSCT), and 20% of cases are related to acute graft-versus-host disease (aGVHD). The underlying mechanisms of this association are unclear, however. The aim of the present study was to investigate the potential mechanisms of SFPR secondary to aGVHD, which may provide a new therapeutic strategy for these patients. A total of 468 patients with malignant hematologic disease who underwent alloHSCT were included. Sixty-six patients developed SFPR after alloHSCT, and in 45 of these 66 patients (68.2%), SFPR was secondary to grade II-IV aGVHD (SFPR/aGVHD). Compared with patients with good graft function (GGF), patients with SFPR had poor overall survival (20.72% versus 88.01%;P <.0001). Grade II-IV aGVHD was identified as an independent risk factor for SFPR in multivariate analysis (hazard ratio, 9.512;P <.0001). We observed reduced erythroid and megakaryocyte colony formation in bone marrow (BM) samples isolated from SFPR/aGVHD patients, consistent with the lower frequency of megakaryocyte and erythrocyte progenitors in BM. Levels of the inflammatory cytokines IL-2R and TNF-R1 were significantly higher in the SFPR/aGVHD group compared with the GGF group (P= .002 and .001, respectively), as were the frequencies of proinflammatory T helper subsets. Furthermore, the pathways that regulate hematopoiesis and immune responses were universally underexpressed in CD34+cells isolated from SFPR/aGVHD patients. Differentially expressed genes were significantly enriched in the hematopoietic cell lineage pathway and other pathways involved in both immune responses and megakaryopoiesis. In summary, we found that both the immune microenvironment and compromised proliferation of hematopoietic primitive cells contribute to the development of SFPR secondary to aGVHD, and our data provide new insight into the mechanisms of SFPR in the context of aGVHD.
