Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands.
Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the Netherlands; Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands.
Blood Rev. 2023 Jul;60:101076. doi: 10.1016/j.blre.2023.101076. Epub 2023 Mar 22.
Poor graft function (PGF) after allogeneic hematopoietic stem cell transplantation (HCT) is a serious complication with high morbidity and mortality. The reported incidence of PGF, its risk factors and outcome vary substantially between studies. This variability may be explained by heterogeneity in patient cohorts and HCT strategies, differences in the underlying causes of cytopenia, as well as by differences in PGF definition. In this systematic review and meta-analysis, we provide an overview of the various PGF definitions used and determined the impact of this variability on the reported incidence and outcome. We searched MEDLINE, EMBASE and Web of Science up to July 2022, for any study on PGF in HCT recipients. We performed random-effect meta-analyses for incidence and outcome and subgroup analyses based on different PGF criteria. Among 69 included studies (14.265 HCT recipients), we found 63 different PGF definitions, using various combinations of 11 common criteria. The median incidence of PGF was 7% (IQR: 5-11%, 22 cohorts). The pooled survival of PGF patients was 53% (95% CI: 45-61%, 23 cohorts). The most commonly reported risk factors associated with PGF were history of cytomegalovirus infection and prior graft-versus-host disease. Incidence was lower in studies with strict cytopenic cutoffs, while survival was lower for primary compared to secondary PGF. This work indicates that a standardized, quantitative definition of PGF is needed to facilitate clinical guideline development and to advance scientific progress.
同种异体造血干细胞移植（HCT）后移植物功能不良（PGF）是一种严重的并发症，发病率和死亡率都很高。PGF 的报告发病率、其危险因素和结果在不同的研究之间存在很大差异。这种变异性可能是由于患者队列和 HCT 策略的异质性、血细胞减少的潜在原因的差异以及 PGF 定义的差异所导致的。在这项系统评价和荟萃分析中，我们概述了用于 PGF 的各种定义，并确定了这种变异性对报告的发病率和结果的影响。我们检索了 MEDLINE、EMBASE 和 Web of Science，截至 2022 年 7 月，以获取任何关于 HCT 受者 PGF 的研究。我们对发病率和结果进行了随机效应荟萃分析，并根据不同的 PGF 标准进行了亚组分析。在纳入的 69 项研究（14265 例 HCT 受者）中，我们发现了 63 种不同的 PGF 定义，使用了 11 种常见标准的各种组合。PGF 的中位发病率为 7%（IQR：5-11%，22 个队列）。PGF 患者的总生存率为 53%（95%CI：45-61%，23 个队列）。与 PGF 相关的最常见报告风险因素是巨细胞病毒感染史和既往移植物抗宿主病。在严格的血细胞减少截断值研究中，发病率较低，而原发性 PGF 的生存率低于继发性 PGF。这项工作表明，需要一个标准化的、定量的 PGF 定义，以促进临床指南的制定和科学的进步。
