Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Biol Blood Marrow Transplant. 2011 May;17(5):710-6. doi: 10.1016/j.bbmt.2010.08.017. Epub 2010 Oct 14.
Allogeneic hematopoietic cell transplantation (HCT) recipients have substantial transfusion requirements. Factors associated with increased transfusions and the extent of blood product use in umbilical cord blood (UCB) recipients are uncertain. We reviewed blood product use in 229 consecutive adult recipients of allogeneic HCT at the University of Minnesota: 147 with leukemia, 82 lymphoma or myeloma; 58% received unrelated UCB and 43% sibling donor peripheral blood stem cell (PBSC) grafts. Although neutrophil recovery was prompt (UCB median 17, range: 2-45 days, and PBSC 14, range: 3-34 days), only 135 of 229 (59% cumulative incidence) achieved red blood cell (RBC) independence and 157 (69%) achieved platelet independence by 6 months. Time to platelet independence was prolonged in UCB recipients (median UCB 41 versus PBSC 14 days) and in patients who had received a prior transplant (median 48 versus 32 days). Patients who received UCB grafts required more RBC through day 60 post-HCT (mean UCB 7.8 (95% confidence interval [CI] 6.7-8.9) versus PBSC 5.2 (3.7-6.7) transfusions, P = .04), and more platelet transfusions (mean 25.2 (95% CI 22.1-28.2) versus 12.9 (9.4-16.4), P < .01) compared to PBSC recipients. Patients receiving myeloablative (MA) conditioning required more RBC and platelet transfusions during the first 2 months post-HCT compared to reduced-intensity conditioning (RIC) (7.4 versus 6.2, P = .30 for RBC; 23.2 versus 17.5, P = .07 for platelets). Despite prompt neutrophil engraftment, UCB recipients had delayed platelet recovery as well as more prolonged and costly blood product requirements. Enhanced approaches to accelerate multilineage engraftment could limit the transfusion-associated morbidity and costs accompanying UCB allotransplantation.
异基因造血细胞移植（HCT）受者有大量的输血需求。与脐带血（UCB）受者输血增加和血液制品使用程度相关的因素尚不确定。我们回顾了在明尼苏达大学接受异基因 HCT 的 229 例连续成人受者的血液制品使用情况：147 例白血病，82 例淋巴瘤或骨髓瘤；58%接受非亲缘 UCB，43%接受同胞供体外周血干细胞（PBSC）移植物。尽管中性粒细胞恢复迅速（UCB 中位数为 17，范围：2-45 天，PBSC 中位数为 14，范围：3-34 天），但仅有 229 例中的 135 例（累计发生率 59%）在 6 个月时实现了红细胞（RBC）独立性，157 例（69%）实现了血小板独立性。UCB 受者的血小板独立性时间延长（UCB 中位数为 41 天，PBSC 中位数为 14 天），以及先前接受过移植的患者（中位数为 48 天，PBSC 中位数为 32 天）。接受 UCB 移植物的患者在 HCT 后 60 天内需要更多的 RBC（UCB 均值 7.8（95%置信区间 [CI] 6.7-8.9）比 PBSC 均值 5.2（3.7-6.7），P =.04），并且需要更多的血小板输注（UCB 均值 25.2（95% CI 22.1-28.2）比 PBSC 均值 12.9（9.4-16.4），P <.01）。与接受减量化强度预处理（RIC）的患者相比，接受清髓性预处理（MA）的患者在 HCT 后前 2 个月需要更多的 RBC 和血小板输注（RBC 为 7.4 比 6.2，P =.30；血小板为 23.2 比 17.5，P =.07）。尽管中性粒细胞植入迅速，但 UCB 受者血小板恢复延迟，血液制品需求时间更长、费用更高。增强多谱系植入的方法可以限制 UCB 同种异体移植相关的输血相关发病率和成本。
