Red blood cell transfusion dependence and outcome after allogeneic peripheral blood stem cell transplantation in patients with de novo myelodysplastic syndrome (MDS).
Red blood cell transfusion dependence and outcome after allogeneic peripheral blood stem cell transplantation in patients with de novo myelodysplastic syndrome (MDS).
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DOI：
10.1016/j.bbmt.2008.08.006
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发表时间：
2008-11
影响因子：
4.3
通讯作者：
Deeg, H. Joachim
中科院分区：
文献类型：
--
作者：
Platzbecker, Uwe;Bornhaeuser, Martin;Germing, Ulrich;Stumpf, Julian;Scott, Bart L.;Kroeger, Nicolaus;Schwerdtfeger, Rainer;Boehm, Alexandra;Kobbe, Guido;Theuser, Catrin;Rabitsch, Werner;Valent, Peter;Sorror, Mohamed L.;Ehninger, Gerhard;Deeg, H. Joachim
关键词：
红细胞输注依赖性（TD）并接受支持性治疗的新发骨髓增生异常综合征（MDS）患者的预后劣于不需要输血的患者。目前尚不清楚TD是否也影响同种异体移植后的结局。因此，我们分析了172例中位年龄51岁的原发MDS患者，TD对高剂量预处理和异基因外周血干细胞移植（PBSCT）后结局的影响。中位随访时间为37个月，PBSCT前TD或非TD患者的3年总生存期（OS）概率无显著差异（p=0.1）。然而，由铁蛋白水平反映的输血负担与更高的严重急性移植物抗宿主病概率（p=0.03）和更高的合并症指数（p=0.01）相关，PBSCT前铁蛋白水平>1000µg/l的患者OS较差（p=0.03）。在多变量分析中，仅骨髓成髓细胞计数（p=0.01）和合并症指数（p=0.001）对OS有显著影响。因此，这些数据并未将TD确定为异基因PBSCT后结局的独立负性预后因素。然而，可能与输血相关的铁超负荷可能通过增加总体合并症而导致移植成功率降低。铁螯合形式的临床干预是否会改善MDS TD患者的同种异体PBSCT结果仍有待确定。
The prognosis of patients with de novo myelodysplastic syndromes (MDS), who are red blood cell transfusion-dependent (TD) and receive supportive care is inferior to that of patients not requiring transfusions. It is unknown, whether TD also affects outcome after allogeneic transplantation. We therefore analyzed in 172 de novo MDS patients, median age 51 years, the impact of TD on outcome after high-dose conditioning and allogeneic peripheral blood stem cell transplantation (PBSCT). With a median follow-up of 37 months the probability of 3-year overall survival (OS) did not differ significantly between patients who were or were not TD before PBSCT (p=0.1). However, transfusion burden, as reflected by ferritin levels, correlated with a higher probability of severe acute graft versus host disease (p=0.03) and a higher comorbidity index (p=0.01), and OS was inferior among patients with ferritin levels >1000µg/l before PBSCT (p=0.03). In multivariate analysis only marrow myeloblast count (p=0.01) and comorbidity index (p=0.001) had a significant impact on OS. Thus, these data did not identify TD as an independent negative prognostic factor for outcome after allogeneic PBSCT. However, iron overload, presumably transfusion-related, may contribute to inferior transplant success by adding to the overall comorbidities. Whether clinical intervention in the form of iron chelation would improve results of allogeneic PBSCT in TD patients with MDS remains to be determined.
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影响因子：
45.3
作者：
Kuendgen, Andrea;Strupp, Corinna;Germing, Ulrich
通讯作者：
Germing, Ulrich
影响因子：
20.3
作者：
Greenberg, P;Cox, C;Bennett, J
通讯作者：
Bennett, J
影响因子：
20.3
作者：
Cutler, CS;Lee, SJ;Horowitz, MM
通讯作者：
Horowitz, MM
影响因子：
3.5
作者：
Kröger, N;Bornhäuser, M;Zander, AR
通讯作者：
Zander, AR
影响因子：
11.4
作者：
Scott, BL;Sandmaier, BM;Deeg, HJ
通讯作者：
Deeg, HJ