Xiao Hongwen, Yang Gaohui, Huang Qiulin, Wei Zhenbin, Gan Zhaoping, Wu Meiqing, Shi Zeyan, Huang Huicheng, Pan Zhaofang, Liu Lianjin, Shi Lingling, Zhang Zhongming, Liu Rongrong, Lai Yongrong
Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi 530021, China.
Ther Adv Hematol. 2024 Dec 10;15:20406207241294054. doi: 10.1177/20406207241294054. eCollection 2024.
Acute graft-versus-host disease (aGvHD) is the primary cause of mortality following allogeneic hematopoietic cell transplantation (HCT).
This study aimed to predict the risk of aGvHD after HCT in patients with thalassemia major using a novel predictive nomogram.
A retrospective study was used to develop the prediction model.
We performed retrospective analyses on 402 consecutive thalassemia patients who underwent HCT. Risk factors for aGvHD were analyzed using Cox proportional regression models. T-lymphocyte subsets were collected from 240 patients at the time of neutrophil engraftment. Least Absolute Shrinkage and Selection Operator regression was utilized to screen the indices, with cut-off values established through restricted cubic spline (RCS) regression. The predictive model was developed by integrating these T-lymphocyte subsets with clinical features, aiming to enhance the accuracy of aGvHD risk prediction.
Among 402 thalassemia patients analyzed post-transplantation, significant independent risk factors for aGvHD included matched unrelated donors, haploid-related donors, peripheral blood stem cell infusions, and donor age older than 40 years. Our RCS analysis indicated a marked increase in aGvHD risk when CD4+ T-cell counts exceeded 36 cells/μL and CD8+ T-cell counts exceeded 43 cells/μL during neutrophil engraftment. The integration of T-lymphocyte subsets with clinical risk factors into a Cox regression model demonstrated good predictive performance for assessing aGvHD risk.
This study presents a novel model designed to predict aGvHD in thalassemia patients post-transplantation by utilizing T-lymphocyte data at the time of engraftment. The model facilitates the creation of personalized treatment plans, aiming to minimize the incidence of aGvHD and improve patient outcomes.
急性移植物抗宿主病（aGvHD）是异基因造血细胞移植（HCT）后死亡的主要原因。
本研究旨在使用一种新型预测列线图预测重型地中海贫血患者HCT后发生aGvHD的风险。
采用回顾性研究来建立预测模型。
我们对402例连续接受HCT的地中海贫血患者进行了回顾性分析。使用Cox比例回归模型分析aGvHD的危险因素。在中性粒细胞植入时从240例患者中收集T淋巴细胞亚群。利用最小绝对收缩和选择算子回归筛选指标，并通过受限立方样条（RCS）回归确定截断值。通过将这些T淋巴细胞亚群与临床特征相结合来建立预测模型，旨在提高aGvHD风险预测的准确性。
在移植后分析的402例地中海贫血患者中，aGvHD的显著独立危险因素包括匹配的无关供体、单倍体相关供体、外周血干细胞输注以及供体年龄大于40岁。我们的RCS分析表明，在中性粒细胞植入期间，当CD4 + T细胞计数超过36个细胞/μL且CD8 + T细胞计数超过43个细胞/μL时，aGvHD风险显著增加。将T淋巴细胞亚群与临床危险因素整合到Cox回归模型中，在评估aGvHD风险方面显示出良好的预测性能。
本研究提出了一种新型模型，旨在通过利用植入时的T淋巴细胞数据预测地中海贫血患者移植后发生的aGvHD。该模型有助于制定个性化治疗方案，旨在将aGvHD的发生率降至最低并改善患者预后。
