Department of Hematology and Oncology, National Clinical Research Center for Child Health and Disorders Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Ann Hematol. 2024 Jul;103(7):2485-2497. doi: 10.1007/s00277-024-05787-9. Epub 2024 May 6.
Cardiotoxicity in children is a potentially fatal complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT); therefore, early identification of risk factors can improve patient prognosis. However, there are few data on the clinical characteristics of early-stage cardiotoxicity in children after allo-HSCT. We conducted a retrospective single-center study of pediatric patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) between January 2016 and December 2022 at the Children's Hospital Affiliated with Chongqing Medical University to evaluate the clinical characteristics of early cardiac events (ECEs) after allo-HSCT and their impact on survival outcomes. We enrolled 444 patients who underwent allo-HSCT-304 males (68%) and 140 females (32%)-with a median age of 3.3 years (1.8-6.5 years) at transplantation. We found that 73 patients (16.4%) had ECEs after allo-HSCT. The ECEs included valvular disease (n = 46), pericardial effusion (n = 38), arrhythmia (n = 9), heart failure (n = 16), and dilated cardiomyopathy (n = 1). Female sex, age ≥ 6 years, body mass index (BMI) < 16 kg/m and HLA-type mismatches were risk factors for ECEs. We designed a stratified cardiac risk score that included these risk factors, and the higher the score was, the greater the cumulative incidence of ECEs. The occurrence of an ECE was closely associated with a lower overall survival (OS) rate and greater nonrelapse mortality (NRM). In addition, stratified analysis based on the number of combined ECEs showed that the greater the number of combined ECEs was, the more significant the negative impact on OS rates.
儿童的心脏毒性是异基因造血干细胞移植（allo-HSCT）后潜在的致命并发症；因此，早期识别危险因素可以改善患者的预后。然而，关于 allo-HSCT 后儿童早期心脏毒性的临床特征的数据很少。我们对 2016 年 1 月至 2022 年 12 月在重庆医科大学附属儿童医院接受异基因造血干细胞移植（allo-HSCT）的儿科患者进行了一项回顾性单中心研究，以评估 allo-HSCT 后早期心脏事件（ECE）的临床特征及其对生存结果的影响。我们纳入了 444 名接受 allo-HSCT 的患者，其中 304 名男性（68%）和 140 名女性（32%），移植时的中位年龄为 3.3 岁（1.8-6.5 岁）。我们发现，73 名患者（16.4%）在 allo-HSCT 后出现 ECE。ECE 包括瓣膜疾病（n=46）、心包积液（n=38）、心律失常（n=9）、心力衰竭（n=16）和扩张型心肌病（n=1）。女性、年龄≥6 岁、体重指数（BMI）＜16kg/m 和 HLA 错配是 ECE 的危险因素。我们设计了一个包含这些危险因素的分层心脏风险评分，评分越高，ECE 的累积发生率越高。ECE 的发生与总生存率（OS）降低和非复发死亡率（NRM）增加密切相关。此外，基于合并 ECE 数量的分层分析表明，合并 ECE 数量越多，对 OS 率的负面影响越显著。
