Center for Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Laboratory Medicine, Hongci Blood Disease Hospital, Suzhou, China.
Pathology. 2024 Dec;56(7):1000-1006. doi: 10.1016/j.pathol.2024.04.014. Epub 2024 Jul 14.
Prolonged thrombocytopenia (PT) is a serious complication after haematopoietic stem cell transplantation (HSCT). PT has been suggested to be associated with an increased platelet transfusion requirement and poor outcomes after transplantation. Due to the complex mechanism of PT development, it is difficult to diagnose in the early post-transplant period. Our study aimed to identify an early predictive marker for PT after HSCT. Previous studies showed that the clinical utility of immature platelet fraction (IPF) predicts platelet recovery after chemotherapy and successful engraftment. However, the relationship between IPF and PT after HSCT remains unclear. Fifty-two patients with malignant haematological diseases who underwent HSCT were included in the study. We observed the kinetics of recovery of haematological parameters after transplantation and performed receiver operating characteristics (ROC) curve analysis using data from the 52 HSCT patients. The days to rise and peak of IPF, absolute IPF count (A-IPF) and highly fluorescent IPF (H-IPF) were almost synchronised in all patients, at day 10 and day 15, respectively. The begin to rise levels of IPF, H-IPF and A-IPF were all significantly lower in the PT group than in the good engraftment (GE) group (p=0.0016, p=0.0094, p=0.0086, respectively). The peak levels of IPF were significantly lower in the PT group than the GE group (p=0.0036). However, the peaks of H-IPF and A-IPF were not statistically significant between the two groups (p=0.3383, p=0.0887, respectively). The area under the ROC curve (AUC) of IPF rise was 0.739 (95% CI 0.583-0.896; p<0.05) and the cut-off value was 3.5%, while the AUC of IPF peak was 0.800 (95% CI 0.637-0.962; p<0.01) and the cut-off value was 8.0%. In conclusion, early low levels of IPF predict the development of PT after HSCT. These findings may help improve the management and treatment strategies for PT after HSCT.
血小板减少症（PT）是造血干细胞移植（HSCT）后的一种严重并发症。PT 已被证明与移植后血小板输注需求增加和预后不良有关。由于 PT 发展的复杂机制，在移植后早期难以诊断。我们的研究旨在确定 HSCT 后 PT 的早期预测标志物。先前的研究表明，不成熟血小板分数（IPF）预测化疗后血小板恢复和成功植入。然而，IPF 与 HSCT 后 PT 的关系尚不清楚。本研究纳入了 52 例恶性血液病患者，观察了移植后血液学参数的恢复动力学，并使用 52 例 HSCT 患者的数据进行了受试者工作特征（ROC）曲线分析。在所有患者中，IPF、绝对 IPF 计数（A-IPF）和高荧光 IPF（H-IPF）的恢复时间和峰值几乎同步，分别在第 10 天和第 15 天。PT 组的 IPF、H-IPF 和 A-IPF 起始升高水平均显著低于良好植入（GE）组（p=0.0016，p=0.0094，p=0.0086）。PT 组的 IPF 峰值显著低于 GE 组（p=0.0036）。然而，两组之间 H-IPF 和 A-IPF 的峰值无统计学差异（p=0.3383，p=0.0887）。IPF 升高的 ROC 曲线下面积（AUC）为 0.739（95%CI 0.583-0.896;p<0.05），截断值为 3.5%，而 IPF 峰值的 AUC 为 0.800（95%CI 0.637-0.962;p<0.01），截断值为 8.0%。总之，早期 IPF 水平低预示着 HSCT 后 PT 的发生。这些发现可能有助于改善 HSCT 后 PT 的管理和治疗策略。
