Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Bone Marrow Transplant. 2019 Dec;54(12):2096-2101. doi: 10.1038/s41409-019-0634-x. Epub 2019 Aug 13.
Early fluid overload has been associated with poor transplant outcomes after allogeneic hematopoietic cell transplantation. However, its effects on the outcomes after cord blood transplantation (CBT) are unclear. We retrospectively analyzed the data of 227 adult patients who received single-unit CBT in our institute. The cumulative incidence of grade ≥2 fluid overload was 4% at day 30 after CBT with a median onset at 16 days (range, 9-30 days) after CBT. In the multivariate analysis, grade ≥2 fluid overload was significantly associated with higher non-relapse mortality (hazard ratio [HR], 5.73; P = 0.011) and overall mortality (HR, 3.81; P = 0.006). Among the entire cohort, 133 patients were treated with low-dose dopamine (0.5-2 µg/kg/min) with a median time of initiation of low-dose dopamine therapy at 10.5 days after CBT. Use of low-dose dopamine significantly increased daily urine output and decreased body weight. These data suggested that early fluid overload was significantly associated with non-relapse and overall mortality after single CBT. The early intervention of low-dose dopamine to prevent early fluid overload is a matter of future investigation for patients undergoing allogeneic hematopoietic cell transplantations (HCT), particularly for CBT.
早期液体超负荷与异基因造血细胞移植后不良移植结果相关。然而，其对脐血移植（CBT）后结果的影响尚不清楚。我们回顾性分析了 227 例在我院接受单份 CBT 的成年患者的数据。CBT 后 30 天，液体超负荷≥2 级的累积发生率为 4%，中位发病时间为 CBT 后 16 天（范围为 9-30 天）。多变量分析显示，液体超负荷≥2 级与较高的非复发死亡率（危险比 [HR]，5.73；P=0.011）和总死亡率（HR，3.81；P=0.006）显著相关。在整个队列中，133 例患者接受小剂量多巴胺（0.5-2μg/kg/min）治疗，CBT 后小剂量多巴胺治疗的中位起始时间为 10.5 天。小剂量多巴胺的使用显著增加了每日尿量并减轻了体重。这些数据表明，单份 CBT 后早期液体超负荷与非复发和总死亡率显著相关。对于接受异基因造血细胞移植（HCT）的患者，特别是 CBT 患者，早期应用小剂量多巴胺预防早期液体超负荷是未来需要研究的问题。
