Late-occurring venous thromboembolism in allogeneic blood or marrow transplant survivors: a BMTSS-HiGHS2 risk model.
Late-occurring venous thromboembolism in allogeneic blood or marrow transplant survivors: a BMTSS-HiGHS2 risk model.
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DOI：
10.1182/bloodadvances.2021004341
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发表时间：
2021-10-26
期刊：
影响因子：
7.5
通讯作者：
Bhatia S
中科院分区：
文献类型：
--
作者：
Gangaraju R;Chen Y;Hageman L;Wu J;Francisco L;Kung M;Weisdorf DJ;Forman SJ;Arora M;Armenian SH;Bhatia S
同种异体骨髓移植存活2年的患者与未患癌症的同胞相比，迟发性静脉血栓栓塞的风险更高。临床风险预测模型能够区分BMT幸存者迟发性静脉血栓栓塞的低风险或高风险。由于高强度治疗暴露、合并症和慢性移植物抗宿主病（GVHD）引起的促炎状态，同种异体血液或骨髓移植（BMT）受者存在静脉血栓栓塞（VTE）的风险。同种异体BMT存活者发生VTE的长期风险尚未研究。参与者来自血液或骨髓移植存活者研究（BMTSS），这是一项回顾性队列研究，包括1974年至2014年期间接受移植并在BMT后存活≥2年的患者。我们分析了1554例同种异体骨髓移植2年存活者与907例同胞的静脉血栓栓塞风险。采用最小化赤池信息准则指导的后向变量选择，我们建立了晚发性静脉血栓栓塞风险的预测模型。同种异体骨髓移植存活者发生静脉血栓栓塞的风险是同胞的7.3倍（95%CI，4.69-11.46; P <0.0001）。在中位随访11年后，以BMT后前2年存活为条件，BMT后5年、10年和20年迟发性VTE的累积发生率分别为2.4%、4.9%和7.1%。BMT后2年的VTE风险的最终模型包括中风史、慢性GVHD、高血压、性别（男性vs女性）和干细胞来源（外周血干细胞vs其他）（“HiGHS 2”）（校正的C-统计量：0.73; 95%CI = 0.67-0.79）。该模型能够将患者分为高和低VTE风险（10年累积发病率分别为9.3%和2.4%; P <0.0001）。BMTSS HiGHS 2风险模型在BMT后2年应用时，可用于为晚期发生VTE的高风险患者提供有针对性的预防策略。
Two-year survivors of allogeneic BMT have a higher risk of late-occurring VTE compared with siblings without cancer. A clinical risk-prediction model is able to discriminate BMT survivors at low or high risk of late-occurring VTE. Allogeneic blood or marrow transplant (BMT) recipients are at risk for venous thromboembolism (VTE) because of high-intensity therapeutic exposures, comorbidities, and a proinflammatory state due to chronic graft-versus-host disease (GVHD). The long-term risk of VTE in allogeneic BMT survivors remains unstudied. Participants were drawn from the Blood or Marrow Transplant Survivor Study (BMTSS), a retrospective cohort study that included patients who underwent transplantation between 1974 and 2014 and survived ≥2 years after BMT. We analyzed the risk of VTE in 1554 2-year survivors of allogeneic BMT compared with 907 siblings. Using backward variable selection guided by minimizing Akaike information criterion, we created a prediction model for risk of late-occurring VTE. Allogeneic BMT survivors had a 7.3-fold higher risk of VTE compared with siblings (95% CI, 4.69-11.46; P < .0001). After a median follow-up of 11 years, conditional on surviving the first 2 years after BMT, the cumulative incidence of late-occurring VTE was 2.4% at 5 years, 4.9% at 10 years, and 7.1% at 20 years after BMT. The final model for VTE risk at 2 years post-BMT included History of stroke, chronic GVHD, Hypertension, Sex (male vs female) and Stem cell source (peripheral blood stem cells vs other) (“HiGHS2”) (corrected C-statistics: 0.73; 95% CI = 0.67-0.79). This model was able to classify patients at high and low VTE risk (10-year cumulative incidence, 9.3% vs 2.4% respectively; P < .0001). The BMTSS HiGHS2 risk model when applied at 2 years post-BMT can be used to inform targeted prevention strategies for patients at high risk for late-occurring VTE.
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同种异体造血干细胞移植后，静脉血栓栓塞与移植物抗宿主疾病和非释放死亡率有关。
影响因子：
10.1
作者：
Kekre N;Kim HT;Ho VT;Cutler C;Armand P;Nikiforow S;Alyea EP;Soiffer RJ;Antin JH;Connors JM;Koreth J
通讯作者：
Koreth J
影响因子：
2.8
作者：
Bhatia S
通讯作者：
Bhatia S
影响因子：
6.2
作者：
Pihusch, M;Lohse, P;Pinhusch, R
通讯作者：
Pinhusch, R
DOI：
10.5500/wjt.v6.i4.608
发表时间：
2016-12-24
期刊：
World journal of transplantation
影响因子：
--
作者：
Presland RB
通讯作者：
Presland RB
影响因子：
20.3
作者：
Gerber, David E.;Segal, Jodi B.;Streiff, Michael B.
通讯作者：
Streiff, Michael B.