Abstract：
Dexamethasone use during hematopoietic cell transplant (HCT) conditioning varies between pediatric centers. This study aimed to estimate the difference in 1-year treatment-related mortality (TRM) between patients who did or did not receive dexamethasone during HCT conditioning. Secondary objectives were to estimate the difference between dexamethasone-exposed and dexamethasone-unexposed groups in 1-year event-free survival (EFS), time to neutrophil engraftment, acute graft-versus-host disease (aGVHD), and invasive fungal disease (IFD) at day + 100. This was a seven-site, international, retrospective cohort study. Patients < 18 years old undergoing their first allogeneic or autologous myeloablative HCT for hematologic malignancy or aplastic anemia between January 1, 2012, and July 31, 2017, were included. To control for potential confounders, propensity score weighting was used to calculate the standardized mean difference for all endpoints. Among 242 patients, 140 received dexamethasone during HCT conditioning and 102 did not. TRM was unaffected by dexamethasone exposure (1.7%; 95% CI - 7.4, 10.2%). Between-group differences in secondary outcomes were small. However, dexamethasone exposure significantly increased possible, probable, and proven IFD incidence (9.0%, 95% CI 0.8, 17.3%). TRM is not increased in pediatric patients who receive dexamethasone during HCT conditioning. Clinicians should consider potential IFD risk when selecting chemotherapy-induced vomiting prophylaxis for pediatric HCT patients.
摘要：
在造血细胞移植（HCT）调理期间使用地塞米松在儿科中心之间有所不同。这项研究旨在评估在HCT预处理期间接受或未接受地塞米松的患者之间1年治疗相关死亡率（TRM）的差异。次要目标是评估地塞米松暴露组和地塞米松未暴露组1年无事件生存期（EFS）的差异，中性粒细胞植入的时间，急性移植物抗宿主病（aGVHD），和侵袭性真菌病(IFD)在第+100天。这是一个七个网站，国际,回顾性队列研究。纳入年龄<18岁的患者，在2012年1月1日至2017年7月31日期间接受首次同种异体或自体清髓性HCT治疗恶性血液病或再生障碍性贫血。为了控制潜在的混杂因素，使用倾向评分加权计算所有终点的标准化平均差.在242名患者中，140人在HCT调理期间接受了地塞米松，102人没有接受。TRM不受地塞米松暴露的影响（1.7％；95％CI-7.4，10.2％）。次要结局的组间差异很小。然而,地塞米松暴露显著增加可能，可能,和证实的IFD发病率(9.0%，95%CI0.8，17.3%）。在HCT调理期间接受地塞米松的儿科患者中，TRM没有增加。临床医生在为小儿HCT患者选择化疗引起的呕吐预防措施时应考虑潜在的IFD风险。
