Liu J, Lyu M, Zhang Y Y, Mo X D, Sun Y Q, Yan C H, Wang Y, Xu L P, Zhang X H, Liu K Y, Huang X J
Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematological Diseases, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematology, Beijing 100044, China.
Zhonghua Xue Ye Xue Za Zhi. 2024 Jun 14;45(6):542-548. doi: 10.3760/cma.j.cn121090-20231030-00240.
To analyze the causes and demographic characteristics of pre-engraftment mortality in patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) and investigate the risk factors and measures for preventing pre-engraftment mortality. A retrospective case analysis, involving a total of 7 427 patients who underwent allo-HSCT at Peking University People's Hospital between January 2016 and July 2023, was conducted. Among the 7 427 patients who underwent allo-HSCT, 56 cases (0.75% ) experienced pre-engraftment mortality. The median time to death for these 56 patients was +7 (-3 to +38) days after stem cell infusion. The median times to death for patients with acute leukemia (AL), severe aplastic anemia (SAA), and myelodysplastic syndrome (MDS) were +11 (-1 to +38), +3 (-1 to +34), and +16 (-1 to +38) days, respectively (=0.013). The main causes of pre-engraftment mortality were infection (39.3% ), cardiac toxicity (28.6% ), and intracranial hemorrhage (26.8% ). Infection was the most common cause of pre-engraftment mortality in patients with AL and MDS (55.0% and 60.0% ), whereas cardiac toxicity was predominantly observed in patients with SAA (71.4% ), with no cases in patients with AL and only one case in patients with MDS. Among patients who died from intracranial hemorrhage, 53.3% had severe infections. The median times to death for infection, cardiac toxicity, and intracranial hemorrhage was +11 (-1 to +38), +2.5 (-1 to +17), and +8 (-3 to +37) days, respectively (<0.001) . Infection is the primary cause of pre-engraftment mortality in allo-HSCT, and severe cardiac toxicity leading to pre-engraftment mortality should be closely monitored in patients with SAA.
分析接受异基因造血干细胞移植（allo-HSCT）患者植入前死亡的原因及人口统计学特征，并探讨植入前死亡的危险因素及预防措施。对2016年1月至2023年7月在北京大学人民医院接受allo-HSCT的7427例患者进行回顾性病例分析。在7427例接受allo-HSCT的患者中，56例（0.75%）发生植入前死亡。这56例患者的中位死亡时间为干细胞输注后+7（-3至+38）天。急性白血病（AL）、重型再生障碍性贫血（SAA）和骨髓增生异常综合征（MDS）患者的中位死亡时间分别为+11（-1至+38）、+3（-1至+34）和+16（-1至+38）天（=0.013）。植入前死亡的主要原因是感染（39.3%）、心脏毒性（28.6%）和颅内出血（26.8%）。感染是AL和MDS患者植入前死亡的最常见原因（分别为55.0%和60.0%），而心脏毒性主要见于SAA患者（71.4%），AL患者无病例，MDS患者仅有1例。在死于颅内出血的患者中，53.3%有严重感染。感染、心脏毒性和颅内出血的中位死亡时间分别为+11（-1至+38）、+2.5（-1至+17）和+8（-3至+37）天（<0.001）。感染是allo-HSCT植入前死亡的主要原因，对于SAA患者，应密切监测导致植入前死亡的严重心脏毒性。
