State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.
Department of Hematology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China.
Front Immunol. 2024 Sep 25;15:1437176. doi: 10.3389/fimmu.2024.1437176. eCollection 2024.
Currently, no study has determined whether platelet transfusion refractoriness (PTR) post-hematopoietic stem cell transplantation (HSCT) before engraftment in patients with myelodysplastic syndrome (MDS) would impacts clinical outcomes.
We performed a MDS-specific retrospective analysis to determine whether PTR in one-month post-HSCT in patients with MDS could influence outcomes.
Among the 315 patients enrolled, 110 (34.9 %) had PTR from stem cell infusion to one-month post-HSCT. Baseline characteristics of the PTR and non-PTR groups were similar. We found that patients with PTR had a slower and lower rate of platelet engraftment by day 28, as well as a slower recovery of neutrophils. The median days of neutrophil and platelet engraftment were 14 days (9-23) and 17 days (8-28) in the PTR groups versus 13 days (9-23) and 15 days (7-28) in the non-PTR group (P<0.001). By day 28, 84 of 110 patients (76.4%) with PTR achieved platelet engraftment compared with 181 of 205 patients (88.3%) without PTR achieving platelet engraftment (P=0.007). In addition, patients in the PTR group received significantly more red blood cell (median, 17 units vs. 10 units, P<0.001) and platelet transfusions (median, 13 units vs. 7 units, P<0.001). However, the overall survival was similar between the two groups. PTR in one-month post-HSCT, haploidentical donor, and ferritin level>1041ng/ml (median level) were independent adverse factors of platelet engraftment.
目前，尚无研究确定骨髓增生异常综合征（MDS）患者造血干细胞移植（HSCT）后未植入前的血小板输注抵抗（PTR）是否会影响临床结局。
我们进行了一项 MDS 特异性回顾性分析，以确定 MDS 患者 HSCT 后 1 个月内的 PTR 是否会影响结局。
在纳入的 315 例患者中，有 110 例（34.9%）在干细胞输注至 HSCT 后 1 个月时出现 PTR。PTR 组和非 PTR 组的基线特征相似。我们发现 PTR 组患者血小板植入的速度较慢，植入率较低，中性粒细胞恢复较慢。PTR 组的中性粒细胞和血小板植入中位天数分别为 14 天（9-23 天）和 17 天（8-28 天），而非 PTR 组分别为 13 天（9-23 天）和 15 天（7-28 天）（P<0.001）。在第 28 天，110 例 PTR 患者中有 84 例（76.4%）实现了血小板植入，而 205 例非 PTR 患者中有 181 例（88.3%）实现了血小板植入（P=0.007）。此外，PTR 组患者接受的红细胞输注（中位数，17 单位 vs. 10 单位，P<0.001）和血小板输注（中位数，13 单位 vs. 7 单位，P<0.001）明显更多。然而，两组的总生存情况相似。HSCT 后 1 个月的 PTR、单倍体相合供者和铁蛋白水平>1041ng/ml（中位水平）是血小板植入的独立不良因素。
