Department of Hematology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
Department of Hematology, soochow university, Suzhou, Jiangsu, China.
Ann Transplant. 2024 Aug 27;29:e944156. doi: 10.12659/AOT.944156.
BACKGROUND Allogeneic hematopoietic stem cell transplantation (allo-HSCT) using umbilical cord blood is a valuable therapy option for patients with acute leukemia (AL). Acute graft-versus-host disease (aGVHD) remains the most frequently encountered complication. This study investigated risk factors for aGVHD and assessed whether post-transplant serum ferritin (SF) within 2 weeks is a potential biomarker for aGVHD in pediatric patients with AL undergoing umbilical cord blood transplantation (UCBT). MATERIAL AND METHODS We conducted a retrospective cohort study of 71 patients with AL who underwent UCBT at the Children's Hospital of Soochow University between 2017 and 2022. We evaluated several factors related to aGVHD. Univariate and multivariate analyses were performed using the proportional subdistribution hazard regression model of Fine and Gray. Analyses of overall survival (OS) were performed using the Kaplan-Meier method, and differences were compared using log-rank tests. RESULTS Of the 71 patients, 23 (32.4%) experienced grade II-IV aGVHD, of whom 18 (25.4%) developed grade III-IV aGVHD. Patients with grade II-IV and III-IV aGVHD had worse 5-year OS (69.4±10%, p=0.01; and 60.6±11.6, P=0.007, respectively). Conditioning intensity was a risk factor for grade III-IV aGVHD (HR: 0.34, 95% CI: 0.13-0.89, P=0.027). An SF level >1650 ng/mL within 2 weeks post-transplant was associated with an increased risk of severe aGVHD (HR: 3.61, 95% CI: 1.09-11.97, P=0.036). CONCLUSIONS Post-transplant SF within 2 weeks was a potential biomarker for developing severe aGVHD. Higher levels of post-transplant SF are associated with a higher incidence of grade II-IV aGVHD and grade III-IV aGVHD.
异体造血干细胞移植（allo-HSCT）使用脐带血是治疗急性白血病（AL）患者的一种有价值的治疗选择。急性移植物抗宿主病（aGVHD）仍然是最常见的并发症。本研究探讨了 aGVHD 的危险因素，并评估了移植后 2 周内血清铁蛋白（SF）是否是接受脐带血移植（UCBT）的 AL 儿科患者发生 aGVHD 的潜在生物标志物。
我们对 2017 年至 2022 年在苏州大学儿童医院接受 UCBT 的 71 例 AL 患者进行了回顾性队列研究。我们评估了与 aGVHD 相关的几个因素。使用 Fine 和 Gray 的比例亚分布风险回归模型进行单变量和多变量分析。使用 Kaplan-Meier 方法进行总生存（OS）分析，并使用对数秩检验比较差异。
在 71 例患者中，23 例（32.4%）发生 II-IV 级 aGVHD，其中 18 例（25.4%）发生 III-IV 级 aGVHD。发生 II-IV 级和 III-IV 级 aGVHD 的患者 5 年 OS 更差（69.4±10%，p=0.01；60.6±11.6，P=0.007）。预处理强度是 III-IV 级 aGVHD 的危险因素（HR：0.34，95%CI：0.13-0.89，P=0.027）。移植后 2 周内 SF 水平>1650ng/mL 与发生严重 aGVHD 的风险增加相关（HR：3.61，95%CI：1.09-11.97，P=0.036）。
移植后 2 周内 SF 是发生严重 aGVHD 的潜在生物标志物。较高的移植后 SF 水平与 II-IV 级 aGVHD 和 III-IV 级 aGVHD 的发生率增加相关。
