Medical Affairs, Cerus Corporation, Concord CA, USA.
Blood. 2011 Jan 20;117(3):1014-20. doi: 10.1182/blood-2010-06-293399. Epub 2010 Oct 8.
Acute lung injury (ALI) during hematopoietic stem cell transplant (HSCT) is associated with substantial morbidity; however, the frequency of ALI in HSCT patients is poorly characterized. Platelets are postulated to play a critical role in the pathogenesis of ALI. Using a transfusion trial of pathogen inactivated platelet components (PC-Test) compared with conventional PC (Reference) populated with HSCT patients, data were reviewed by an adjudication panel to determine the frequency of ALI overall, by treatment groups, and key outcomes: PC exposure, ventilator-free days, and mortality. The diagnosis of ALI was based on American European Consensus Criteria. Of 645 patients who received PC over 28 days, 100 (15.5%) had clinically serious pulmonary adverse events, and 35 (5.4%) met criteria for ALI. Days of platelet support and number of platelet transfusions for patients with ALI were not significantly different from patients without ALI (P > .05). Mortality was greater for patients with ALI (57%) than those without (17%, P < .001) but not significantly different between treatment groups. For patients with ALI, the distributions of time to onset of mechanical ventilation were significantly different (P = .04). Patients supported with Reference PC were more likely to be ventilated sooner than patients receiving Test PC.
造血干细胞移植（HSCT）期间的急性肺损伤（ALI）与较高的发病率相关；然而，HSCT 患者中 ALI 的发生频率尚不清楚。血小板被认为在 ALI 的发病机制中发挥关键作用。通过一项与常规血小板成分（PC）比较的病原体灭活血小板成分（PC-Test）输血试验，对 HSCT 患者进行了分组，并由裁决小组对数据进行了审查，以确定总体 ALI 的发生率，按治疗组和关键结果进行分组：PC 暴露、无呼吸机天数和死亡率。ALI 的诊断基于美国欧洲共识标准。在接受 PC 治疗 28 天的 645 名患者中，有 100 名（15.5%）发生了临床严重肺部不良事件，有 35 名（5.4%）符合 ALI 标准。ALI 患者和无 ALI 患者的血小板支持天数和血小板输注次数无显著差异（P＞.05）。ALI 患者的死亡率（57%）高于无 ALI 患者（17%，P＜.001），但两组之间死亡率无显著差异。对于 ALI 患者，机械通气开始时间的分布差异具有统计学意义（P＝.04）。接受 Test PC 治疗的患者比接受 Reference PC 治疗的患者更早需要通气。
