Griffith Linda M, VanRaden Mark, Barrett A John, Childs Richard W, Fowler Daniel H, Kang Elizabeth M, Tisdale John F, Klein Harvey G, Stroncek David F
Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
Transfusion. 2019 Jan;59(1):303-315. doi: 10.1111/trf.14966. Epub 2018 Oct 26.
Patients undergoing allogeneic hematopoietic stem cell transplant require variable, often extensive transfusion support. Identification of factors that predict urgent, intensive, or special needs should improve management of these patients.
This is a retrospective study of red blood cell (RBC) and platelet transfusion support provided for sequential matched sibling donor allogeneic transplants conducted at the Clinical Center, National Institutes of Health, from 1993 through 2010. Factors potentially important for predicting quantity of RBC and platelet transfusions, and time to transfusion independence through Day 200 following hematopoietic stem cell transplantation were evaluated.
Subjects (n = 800) received 10,591 RBC and 10,199 platelet transfusions. Multivariable analysis demonstrated that the need for RBC pretransplant, CD34+ dose, transplant year, diagnostic category, and ABO match were significantly independently associated with quantity of RBC transfusions during Days 0 through 30. Only pretransplant need for RBCs, CD34+ dose, and transplant year had significance during Days 0 through 100. Similar analyses for quantity of platelet transfusions demonstrated that for both Days 0 through 30 and 0 through 100 significant factors were need for platelet support before transplant, CD34+ dose, transplant year, and transplant regimen. Of note, long term, during Days 101 through 200, only CD34+ dose remained significant for quantity of RBC and platelet transfusions. Analysis of time to transfusion independence demonstrated that patients with ABO major mismatches required longer to achieve freedom from RBC transfusion support compared to identical matches or those with minor mismatches.
Patient-specific factors including CD34+ dose and ABO match of the graft should be given particular consideration by transfusion services when planning support of patients receiving allogeneic hematopoietic stem cell transplant.
接受异基因造血干细胞移植的患者需要不同程度、通常是大量的输血支持。识别预测紧急、强化或特殊需求的因素应能改善这些患者的管理。
这是一项回顾性研究,对1993年至2010年在美国国立卫生研究院临床中心进行的连续匹配同胞供体异基因移植所提供的红细胞(RBC)和血小板输血支持进行分析。评估了对预测RBC和血小板输血量以及造血干细胞移植后第200天实现输血独立时间可能重要的因素。
研究对象(n = 800)接受了10,591次RBC输血和10,199次血小板输血。多变量分析表明,移植前对RBC的需求、CD34+剂量、移植年份、诊断类别和ABO血型匹配与第0天至30天期间的RBC输血量显著独立相关。仅移植前对RBC的需求、CD34+剂量和移植年份在第0天至100天期间具有显著性。对血小板输血量的类似分析表明,在第0天至30天和第0天至100天,重要因素均为移植前对血小板支持的需求、CD34+剂量、移植年份和移植方案。值得注意的是,在第101天至200天的长期期间,仅CD34+剂量对RBC和血小板输血量仍具有显著性。对输血独立时间的分析表明,与血型完全匹配或轻微不匹配的患者相比,ABO主要不匹配的患者实现RBC输血支持独立所需时间更长。
输血服务机构在规划对接受异基因造血干细胞移植患者的支持时,应特别考虑包括移植的CD34+剂量和ABO血型匹配在内的患者特异性因素。