Incidence, Risk Factors, and Outcomes of Primary Poor Graft Function after Allogeneic Hematopoietic Stem Cell Transplantation
Incidence, Risk Factors, and Outcomes of Primary Poor Graft Function after Allogeneic Hematopoietic Stem Cell Transplantation
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异基因造血干细胞移植后原发性移植物功能不良的发生率、危险因素和结果
DOI：
10.1016/j.bbmt.2019.05.036
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发表时间：
2019-09-01
影响因子：
4.3
通讯作者：
Huang, He
中科院分区：
文献类型：
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作者：
Zhao, Yanmin;Gao, Fei;Huang, He
异基因造血干细胞移植（allo-HSCT）是治疗恶性和非恶性血液病的有效方法。然而，原发性移植物功能不良（PGF）是allo-HSCT的严重早期并发症，导致预后不良。关于allo-HSCT后发生原发性PGF的特点、发病率和危险因素知之甚少。在此，我们对2013年4月至2018年11月期间在我们中心接受allo-HSCT的830例患者进行了1：4比例的巢式病例对照研究。24例患者（14例男性和10例女性;平均年龄，35.79岁;范围，17至53岁）发展为原发性PGF。在单变量和多变量分析中，CD 34（+）细胞剂量2000 ng/mL（P= 0.008）和脾肿大（P = 0.039）被确定为原发性PGF的3个独立危险因素。中位随访7.5个月（范围1 - 48个月）后，仅5例患者（20.8%）存活。原发性PGF患者的生存率明显低于移植物功能良好（GGF）患者（1年总生存率，25.0%对90.6%; P <0.001）。考克斯回归分析提示PGF和高SF水平与这些患者的快速死亡密切相关。总之，对于移植物中CD 34（+）细胞剂量低、SF水平高和脾肿大的allo-HSCT受者，应监测allo-HSCT后原发性PGF的发生，并探索有效的治疗方法。(C)2019年美国移植和细胞治疗学会。爱思唯尔公司出版
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative therapy for both malignant and nonmalignant hematologic disorders. However, primary poor graft function (PGF) is a serious early complication of allo-HSCT that leads to a poor outcome. Little is known about the characteristics, incidence, and risk factors of primary PGF occurring after allo-HSCT. Here we performed a 1:4 ratio nested case-control study in 830 patients who underwent allo-HSCT between April 2013 and November 2018 at our center. Twenty-four patients (14 males and 10 females; average age, 35.79 years; range, 17 to 53 years) developed primary PGF. On univariate and multivariate analyses, a CD34(+) cell dose 2000 ng/mL (P=.008), and splenomegaly (P = .039) were identified as 3 independent risk factors for primary PGF. After a median follow-up of 7.5 months (range, 1 to 48 months), only 5 patients (20.8%) survived. The survival rate of patients with primary PGF was significantly lower than that of patients with good graft function (GGF) (1-year overall survival, 25.0% versus 90.6%; P < .001). Cox regression analysis suggested that PGF and high SF level were strongly associated with rapid death in these patients. In conclusion, allo-HSCT recipients with a low CD34(+) cell dose in their graft and exhibiting a high SF level and splenomegaly should be monitored for the development of primary PGF after allo-HSCT, and effective therapies need to be explored. (C) 2019 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.