St. Johns Medical College, Bangalore, India.
Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA.
Transfusion. 2021 Jul;61(7):2064-2074. doi: 10.1111/trf.16413. Epub 2021 Apr 26.
Transfusions are essential for allogeneic hematopoietic cell transplant (HCT), yet they are influenced by graft, donor, and other factors.
We analyzed transfusions in 165 adult reduced intensity HCTs (2016-2019): HLA matched sibling donor (MSD) (n = 59), matched URD (n = 25), UCB (n = 33), and haploidentical (haplo, n = 48) detailing the cumulative incidence of platelet and RBC transfusion independence, total transfusions (day-10 to day+100) plus transfusion densities (per week) over 110 days.
Platelet recovery to 20 × 10 /L by 6 months occurred in 39/48 (81.25%) haplo recipients (median 33 [range, 0-139]) days vs. 58/59 (98.3%) MSD (median 10 [0-37]), 21/25 (84%) matched URD (median 20 [0-153]), and 29/33 (87.87%) UCB (median 48 [29-166]) days, p < .01. Regression analysis demonstrated a lower likelihood of prompt platelet recovery in matched URD, UCB, or haplo HCTs vs. MSD. Recovery to platelet independence was quickest in MSD (median 8 days [range 0-94]), vs. URD (median 16 days [0-99]), UCB (median 57 [0-94]), or haplo (median 45 [12-97]) days, p < .01. Platelet needs were unaffected by age, conditioning, or acute GVHD. RBC transfusion independence was achieved in 78% of MSD, 64% URD, and 82% UCB, though less frequent (58%) and slowest in haplo recipients, p < .01. All haplo and UCB recipients required platelet transfusions vs. only 51% of MSD and 76% of URD. RBC needs were highest in UCB and haplo HCTs.
The transplant donor influences the transfusion burden with greater platelet and RBC needs in haplo and UCB HCT which directly contributes to increased cost of care.
同种异体造血细胞移植（HCT）中需要输血，但输血会受到移植物、供者和其他因素的影响。
我们分析了 165 例成人强度降低的 HCT（2016-2019 年）：HLA 匹配的同胞供者（MSD）（n=59）、匹配的非亲缘供者（URD）（n=25）、脐血（UCB）（n=33）和单倍体相合（haplo，n=48），详细描述了血小板和红细胞输血独立性的累积发生率、总输血（第 10 天至第 100 天）和 110 天内每周的输血密度。
在 48 例 haplo 受者中，有 39 例（81.25%）在 6 个月内血小板恢复至 20×10 /L（中位数 33[范围 0-139]天），而 59 例 MSD（98.3%）、25 例匹配 URD（84%）（中位数 20[0-153]天）和 33 例 UCB（87.87%）（中位数 48[29-166]天），p<0.01。回归分析显示，匹配 URD、UCB 或 haplo HCT 中血小板恢复的可能性低于 MSD。MSD（中位数 8 天[范围 0-94]）中血小板独立性恢复最快，而 URD（中位数 16 天[0-99]）、UCB（中位数 57 天[0-94]）或 haplo（中位数 45 天[12-97]），p<0.01。血小板需求不受年龄、调理或急性移植物抗宿主病的影响。MSD 中 78%、URD 中 64%和 UCB 中 82%达到红细胞输血独立性，但 haplo 受者的比例较低（58%）且较慢，p<0.01。所有 haplo 和 UCB 受者需要血小板输注，而 MSD 仅 51%和 URD 76%需要。UCB 和 haplo HCT 的红细胞需求最高。
移植供者影响输血负担，haplo 和 UCB HCT 的血小板和红细胞需求更大，这直接导致了治疗费用的增加。
