Abstract：
The impact of absolute neutrophil count (ANC) before allogenic hematopoietic stem cell transplantation (HSCT) on the outcomes for patients with aplastic anemia (AA) remains unclear. We retrospectively evaluated the relationship between ANC before transplantation and patient outcomes, involving 883 adult Japanese patients with AA who underwent allogeneic HSCT as their first transplantation between 2008 and 2020. Patients were divided into three groups based on ANC: 0/µL (n = 116); 1-199 (n = 210); and ≥ 200 (n = 557). In the low ANC groups (ANC < 200), patient age was higher, previous anti-thymocyte globulin (ATG) treatments were infrequent, duration from diagnosis to transplantation was shorter, hematopoietic cell transplantation-comorbidity index (HCT-CI) was higher, ATG-based conditioning was used infrequently, and peripheral blood stem cell from related donor and cord blood were used frequently. In multivariate analysis, patient age, previous ATG treatment, HCT-CI, stem cell source, and ANC before transplantation were significantly associated with 5-year overall survival (OS) (\"ANC ≥ 200\": 80.3% vs. \"ANC 1-199\": 71.7% vs. \"ANC 0\": 64.4%). The cumulative incidence of bacterial infection, invasive fungal disease, and early death before engraftment were significantly higher in the low ANC groups. Among patients with ANC of zero before transplantation, younger patient age, shorter duration from diagnosis to transplantation, HCT-CI of 0, and bone marrow from related donor as stem cell source were significantly associated with better OS. Consequently, ANC before allogeneic HSCT was found to be a significant prognostic factor in adult patients with AA. Physicians should pay attention to ANC before transplantation.
摘要：
异基因造血干细胞移植（HSCT）前中性粒细胞绝对计数（ANC）对再生障碍性贫血（AA）患者预后的影响尚不清楚。我们回顾性评估了移植前ANC与患者预后之间的关系，涉及883名日本成年AA患者，他们在2008年至2020年间首次接受同种异体HSCT移植。根据ANC将患者分为三组：0/µL（n=116）;1-199（n=210）;和≥200（n=557）。在低ANC组(ANC<200)中，患者年龄较高，以前的抗胸腺细胞球蛋白（ATG）治疗很少，从诊断到移植的持续时间较短，造血细胞移植合并症指数（HCT-CI）较高，基于ATG的调理很少使用，并且经常使用来自相关供体和脐带血的外周血干细胞。在多变量分析中，患者年龄,以前的ATG治疗，HCT-CI，干细胞来源，移植前ANC与5年总生存率（OS）显着相关（“ANC≥200”：80.3％vs.“ANC1-199”：71.7%vs.“ANC0”：64.4%）。细菌感染的累积发生率，侵袭性真菌病,在低ANC组中，植入前的早期死亡明显更高。在移植前ANC为零的患者中，患者年龄较小，从诊断到移植的持续时间较短，0的HCT-CI和来自相关供者的骨髓作为干细胞来源与较好的OS显著相关。因此,发现同种异体HSCT之前的ANC是成年AA患者的重要预后因素。医师在移植前应注意ANC。
