Servicio de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
Servicio de Hematología, Hospital Universitario de Burgos, Burgos, Spain.
Br J Haematol. 2015 Jun;169(5):719-25. doi: 10.1111/bjh.13344. Epub 2015 Mar 26.
Bleeding is a frequent complication after allogeneic haematopoietic stem cell transplantation (HSCT) and may affect survival. The purpose of this study was to determine the incidence and risk factors for life-threatening bleeding after HSCT by retrospective evaluation of 491 allogeneic HSCT recipients. With a median follow-up of 33 months, 126 out of 491 allogeneic HSCT recipients experienced a haemorrhagic event (25·7%) and 46 patients developed a life-threatening bleeding episode (9·4%). Pulmonary and gastrointestinal bleeding were the most common sites for life-threatening bleeding, followed by central nervous system. In multivariate analyses, the presence of severe thrombocytopenia after day +28 and the development of grade III-IV acute graft-versus-host disease (GVHD) or thrombotic microangiopathy (TMA) retained their association with life-threatening bleeding events. The overall survival at 3 years among patients without bleeding was 67·1% for only 17·1% for patients with life-threatening bleeding (P < 0·001). In conclusion, life-threatening bleeding is a common complication after allogeneic HSCT. Prolonged severe thrombocytopenia, acute grade III-IV GVHD and TMA were associated with its development.
出血是异基因造血干细胞移植（HSCT）后的常见并发症，并可能影响生存。本研究通过回顾性评估 491 例异基因 HSCT 受者，旨在确定 HSCT 后危及生命的出血的发生率和危险因素。中位随访 33 个月后，491 例异基因 HSCT 受者中有 126 例（25.7%）发生出血事件，46 例发生危及生命的出血事件（9.4%）。危及生命的出血最常见的部位是肺部和胃肠道出血，其次是中枢神经系统。多变量分析显示，+28 天后严重血小板减少和发生 3 级或 4 级急性移植物抗宿主病（GVHD）或血栓性微血管病（TMA）与危及生命的出血事件相关。无出血患者的 3 年总生存率为 67.1%，而有危及生命的出血患者的总生存率仅为 17.1%（P<0.001）。总之，危及生命的出血是异基因 HSCT 后的常见并发症。持续性严重血小板减少、急性 3 级或 4 级 GVHD 和 TMA 与出血的发生相关。
