Department of Hematology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China.
Anhui Provincial Key Laboratory of Blood Research and Applications, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
Hematol Oncol. 2022 Feb;40(1):82-91. doi: 10.1002/hon.2937. Epub 2021 Oct 24.
Prolonged isolated thrombocytopenia (PIT) is a common complication after umbilical cord blood transplantation (UCBT). However, data on PIT prediction and impacts on transplantation outcomes for UCBT patients are rare. We retrospectively analyzed 244 patients with hematological malignancies who received single-unit UCBT at the First Affiliated Hospital of USTC between August 2018 and December 2019. Among them, PIT occurred in 49 recipients, with a crude incidence of 20.1%. In the PIT patients, the 2-year cumulative incidence of transplant-related mortality (TRM) was significantly higher, and the probabilities of 2-year overall survival, leukemia-free survival and graft-versus-host disease (GVHD)-free relapse-free survival were significantly poorer (57.1% vs. 88.6%; 53.1% vs. 81.9%; 22.4% vs. 59.8%; p < 0.001), without remarkable increases in the cumulative incidence of relapse or chronic GVHD. Importantly, the multivariate analysis revealed that lower high-resolution HLA compatibility (≤6/10), lower infused CD34 cell count (≤1.78 × 10 /kg), grade II-IV acute GVHD preplatelet engraftment, a lower pretransplantation platelet count (≤100 × 10 /L), and a longer neutrophil engraftment time (≥17 days) were independent risk factors for PIT after UCBT. These results demonstrate that PIT is common after UCBT, predicting inferior survival and the need for more monitoring during the early phase.
孤立性血小板减少症（Prolonged isolated thrombocytopenia，PIT）是脐带血移植（umbilical cord blood transplantation，UCBT）后的常见并发症。然而，关于 PIT 的预测以及其对 UCBT 患者移植结局的影响的数据却很少。我们回顾性分析了 2018 年 8 月至 2019 年 12 月在我院接受单份 UCBT 的 244 例血液系统恶性肿瘤患者。其中 49 例患者发生 PIT，发生率为 20.1%。在 PIT 患者中，2 年累积移植相关死亡率（transplant-related mortality，TRM）显著升高，2 年总生存率、无白血病生存率和无移植物抗宿主病（graft-versus-host disease，GVHD）-无复发存活率显著降低（57.1% vs. 88.6%；53.1% vs. 81.9%；22.4% vs. 59.8%；p < 0.001），而复发率或慢性 GVHD 的累积发生率无显著增加。重要的是，多因素分析显示，高分辨率 HLA 配型较低（≤6/10）、输注的 CD34 细胞计数较低（≤1.78×10 /kg）、血小板植入前 II-IV 级急性 GVHD、移植前血小板计数较低（≤100×10 /L）和中性粒细胞植入时间较长（≥17 天）是 UCBT 后发生 PIT 的独立危险因素。这些结果表明，PIT 在 UCBT 后很常见，预测生存率较低，需要在早期阶段进行更多监测。
