Abstract：
Primary graft failure (PGF) and multi-lineage cytopenia (MLC) increase the risk of nonrelapse mortality in allogeneic hematopoietic cell transplants (HCT). We evaluated the impact of post-transplant cyclophosphamide (PTCy) and splenomegaly on PGF and MLC for hematological malignancies. This study included patients with PTCy (N=84) and conventional graft-vs.-host disease prophylaxis (N=199). The occurrence of splenomegaly varied widely, ranging from 17.1 % (acute myeloid leukemia) to 66.7 % (myeloproliferative neoplasms). Ten patients (N=8 in the PTCy and N=2 in the non- PTCy) developed PGF, and 44 patients developed MLC (both N=22). PTCy and severe splenomegaly (≥20 cm) were risk factors for PGF (odds ratio (OR): 10.40, p<0.01 and 6.74, p=0.01 respectively). Moreover, severe splenomegaly was a risk factor for PGF in PTCy patients (OR: 10.20, p=0.01). PTCy (hazard ratio (HR) 2.09, p=0.02), moderate (≥15, <20 cm, HR 4.36, p<0.01), and severe splenomegaly (HR 3.04, p=0.01) were independent risk factors for MLC. However, in subgroup analysis in PTCy patients, only mild splenomegaly (≥12, <15 cm, HR 4.62, p=0.01) was a risk factor for MLC. We recommend all patients be screened for splenomegaly before HCT, and PTCy is cautioned in those with splenomegaly.
摘要：
原发性移植物衰竭（PGF）和多谱系血细胞减少症（MLC）增加异基因造血细胞移植（HCT）的非复发死亡风险。我们评估了移植后环磷酰胺（PTCy）和脾肿大对血液恶性肿瘤的PGF和MLC的影响。这项研究包括PTCy（N=84）和常规移植物的患者。-宿主疾病预防(N=199)。脾肿大的发生差异很大，范围从17.1％（急性髓细胞性白血病）到66.7％（骨髓增殖性肿瘤）。10名患者（PTCy中N=8，非PTCy中N=2）发生PGF，44例患者发生MLC（均为N=22）。PTCy和严重脾肿大（≥20cm）是PGF的危险因素（比值比（OR）：10.40，p<0.01和6.74，p=0.01）。此外，严重脾肿大是PTCy患者发生PGF的危险因素(OR:10.20,p=0.01).PTCy（危险比（HR）2.09，p=0.02），中度(≥15，<20厘米，HR4.36，p<0.01），严重脾肿大（HR3.04，p=0.01）是MLC的独立危险因素。然而,在PTCy患者的亚组分析中，仅轻度脾肿大（≥12，<15厘米，HR4.62，p=0.01）是MLC的危险因素。我们建议所有患者在HCT前筛查脾肿大，对于脾肿大的患者，应注意PTCy。
