National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
Platelets. 2023 Dec;34(1):2229905. doi: 10.1080/09537104.2023.2229905.
Platelet transfusion refractoriness (PTR) is an intractable issue in hematological patients, which increases bleeding risks and hospitalization costs to a great extent. We reviewed 108 patients with hematological diseases including acute leukemia, myelodysplastic syndrome, aplastic anemia, and others who received allogeneic hematopoietic stem cell transplantation (HSCT) from January 2019 through December 2020. After multivariable logistic regression, we found that splenomegaly (odds ratio [OR] = 26.98, < .001) and JAK mutation (OR = 17.32, = .024) were independent risk factors for PTR. During the period of transplantation, patients in the PTR group had a significantly higher platelet transfusion demand, which was reflected in the increased number of platelet transfusions (10.23 ± 6.696 vs. 5.06 ± 1.904, < .001). After multivariate adjustment, PTR turned out to be independently associated with worse overall survival (hazard ratio = 2.794, 95% confidence interval = 1.083-7.207, = .034). In conclusion, we found that splenomegaly and JAK gene mutation were independent risk factors for PTR in patients with hematological diseases. A history of PTR prior to allo-HSCT indicates a poor prognosis.
血小板输注无效（PTR）是血液病患者的一个棘手问题，在很大程度上增加了出血风险和住院费用。我们回顾了 2019 年 1 月至 2020 年 12 月期间接受异基因造血干细胞移植（HSCT）的 108 例血液病患者，包括急性白血病、骨髓增生异常综合征、再生障碍性贫血等。经过多变量逻辑回归，我们发现脾肿大（比值比[OR] = 26.98， < .001）和 JAK 突变（OR = 17.32， = .024）是 PTR 的独立危险因素。在移植期间，PTR 组患者的血小板输注需求明显更高，这反映在血小板输注次数的增加（10.23 ± 6.696 与 5.06 ± 1.904， < .001）。经过多变量调整后，PTR 与总体生存不良独立相关（危险比 = 2.794，95%置信区间 = 1.083-7.207， = .034）。总之，我们发现脾肿大和 JAK 基因突变是血液病患者 PTR 的独立危险因素。 allo-HSCT 前有 PTR 史提示预后不良。
