Oyama Takashi, Honda Akira, Masuda Yasutaka, Morita Ken, Maki Hiroaki, Masamoto Yosuke, Kurokawa Mineo
Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan.
Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Bunkyo-Ku, Tokyo, Japan.
Clin Transplant. 2025 Jan;39(1):e70072. doi: 10.1111/ctr.70072.
Pleural effusion and ascites developing after allogeneic hematopoietic stem cell transplantation (allo-SCT) are generally associated with inferior overall survival (OS); however, the prognostic value of pretransplant effusion on transplant outcomes remained unclear.
We retrospectively evaluated minimal pleural effusion and ascites detected by computed tomography in 248 consecutive adult patients who underwent their first allo-SCT from January 2007 to December 2022.
Forty-eight patients demonstrated minimal pleural effusion or ascites within 100 days before transplantation (Effusion group) and the other 200 had no effusion (No effusion group). Serum albumin level was significantly lower in the Effusion group than in the No effusion group (median 3.8 vs. 3.4 g/dL, p < 0.001). Performance status (PS) was significantly inferior and refined disease risk index tended to be higher in the Effusion group. The 2-year OS rate after transplantation was significantly worse in the Effusion group (57.1% vs. 36.7%, p < 0.001). The Effusion group had a significantly lower cumulative incidence of neutrophil and platelet engraftment and higher hepatic veno-occlusive disease. Moreover, a tendency toward higher cumulative incidence of relapse and non-relapse mortality was shown in the Effusion group. In multivariate analysis, the Effusion group had a significantly inferior OS with a hazard ratio of 1.848 (95% confidence interval 1.231-2.774), even after adjustment for disease risk, serum albumin level, PS, and Hematopoietic Cell Transplant-Comorbidity Index points.
Reflecting high disease activity and impaired general condition, pretransplant effusion can be a complementary indicator for poor prognosis in allo-SCT.
异基因造血干细胞移植（allo-SCT）后出现的胸腔积液和腹水通常与总体生存率（OS）较低相关；然而，移植前积液对移植结局的预后价值仍不清楚。
我们回顾性评估了2007年1月至2022年12月期间连续接受首次allo-SCT的248例成年患者通过计算机断层扫描检测到的微量胸腔积液和腹水。
48例患者在移植前100天内出现微量胸腔积液或腹水（积液组），另外200例无积液（无积液组）。积液组的血清白蛋白水平显著低于无积液组（中位数3.8 vs. 3.4 g/dL，p < 0.001）。积液组的体能状态（PS）明显较差，疾病风险指数也往往较高。移植后2年的OS率在积液组明显更差（57.1% vs. 36.7%，p < 0.001）。积液组中性粒细胞和血小板植入的累积发生率显著较低，肝静脉闭塞病发生率较高。此外，积液组显示出复发和非复发死亡率的累积发生率有升高趋势。在多变量分析中，即使在调整疾病风险、血清白蛋白水平、PS和造血细胞移植合并症指数评分后，积液组的OS仍显著较差，风险比为1.848（95%置信区间1.231 - 2.774）。
移植前积液反映了高疾病活动度和一般状况受损，可作为allo-SCT预后不良的补充指标。
