血小板输注难治性(PTR)是血液学患者的棘手问题,这在很大程度上增加了出血风险和住院费用。我们回顾了108例血液病患者,包括急性白血病,骨髓增生异常综合征,再生障碍性贫血,以及在2019年1月至2020年12月期间接受异基因造血干细胞移植(HSCT)的其他人.经过多变量逻辑回归,我们发现脾肿大(比值比[OR]=26.98,p<.001)和JAK突变(OR=17.32,p=.024)是PTR的独立危险因素.在移植期间,PTR组患者的血小板输注需求明显更高,这反映在血小板输注次数增加(10.23±6.696vs.5.06±1.904,p<.001)。经过多变量调整后,PTR与较差的总生存期独立相关(风险比=2.794,95%置信区间=1.083-7.207,p=.034)。总之,我们发现脾肿大和JAK基因突变是血液病患者PTR的独立危险因素。在allo-HSCT之前的PTR病史表明预后不良。
背景是什么?血小板输注难治性是一个关键问题,它大大增加了出血风险和住院费用。患有血液病的患者倾向于发展PTR。PTR由免疫和非免疫因素引起,后者占80-90%。目前,很少有研究关注PTR的诱发因素,具体机制尚不清楚。什么是新的?在这项研究中,我们调查了2019年1月至2020年12月接受异基因HSCT治疗的108例血液病患者.我们发现脾肿大和JAK基因突变是血液病患者PTR的独立危险因素。PTR对HSCT后患者的预后有被动影响,移植后OS恶化和血小板降低的趋势表明。PTR可能影响移植后巨核细胞的重建。影响是什么?这项研究提供了证据,血液系统脾肿大患者应警惕PTR的发生,这通常表明移植预后较差。脾减少和JAK抑制剂治疗PTR值得探索。缩写PLT:血小板;PTR:血小板输注难治性;HSCT:造血干细胞移植;OR:比值比;HR:危险比;CI:置信区间;IQR:四分位数间距;SD:标准差;HLA:人类白细胞抗原;HPA:人类血小板抗原;OS:总体生存率;RFS:无复发生存率;PI:输注后骨髓增生性白血病;MPM:骨髓增生性白血病:完全增生性骨髓增生性白血病;CAD;
Platelet transfusion refractoriness (PTR) is an intractable issue in hematological patients, which increases bleeding risks and hospitalization costs to a great extent. We reviewed 108 patients with hematological diseases including acute leukemia, myelodysplastic syndrome, aplastic anemia, and others who received allogeneic hematopoietic stem cell transplantation (HSCT) from January 2019 through December 2020. After multivariable logistic regression, we found that
splenomegaly (odds ratio [OR] = 26.98, p < .001) and JAK mutation (OR = 17.32, p = .024) were independent risk factors for PTR. During the period of transplantation, patients in the PTR group had a significantly higher platelet transfusion demand, which was reflected in the increased number of platelet transfusions (10.23 ± 6.696 vs. 5.06 ± 1.904, p < .001). After multivariate adjustment, PTR turned out to be independently associated with worse overall survival (hazard ratio = 2.794, 95% confidence interval = 1.083-7.207, p = .034). In conclusion, we found that
splenomegaly and JAK gene mutation were independent risk factors for PTR in patients with hematological diseases. A history of PTR prior to allo-HSCT indicates a poor prognosis.
What is the context?Platelet transfusion refractoriness is a critical issue, and it greatly increases bleeding risks and hospitalization costs.Patients with hematological diseases tend to develop PTR.PTR results from immune and nonimmune factors and the latter account for 80–90%.At present, there are few studies focused on the inducing factors of PTR, and the specific mechanism is not clear.What is new?In this
study, we investigated 108 patients with hematological disorders who received allogeneic HSCT from January 2019 to December 2020.We found that
splenomegaly and JAK gene mutation were independent risk factors for PTR in patients with hematological diseases.PTR had a passive effect on the prognosis of patients after HSCT, as indicated by worse OS and a trend toward lower platelets after transplantation.PTR might affect megakaryocyte reconstitution after transplantation.What is the impact?This
study provides evidence that hematological patients with
splenomegaly should be alert to the occurrence of PTR, which often indicates a worse prognosis of transplantation.Spleen reduction and JAK inhibitors in the treatment of PTR are worth exploring.AbbreviationsPLT: platelets; PTR: platelet transfusion refractoriness; HSCT: hematopoietic stem cell transplantation; OR: odds ratio; HR: hazard ratio; CI: confidence interval; IQR: interquartile range; SD: standard deviation; HLA: human leukocyte antigen; HPA: human platelet antigen; OS: overall survival; RFS: relapse free survival; PI: post-transfusion increment; PPR: percentage platelet recovery; CCI: corrected count increment; ICU: intensive care unit; AA: aplastic anemia; MDS: myelodysplastic syndrome; AML: acute myeloid leukemia; ALL: acute lymphocytic leukemia; CML: chronic myeloid leukemia; CMML: chronic myelomonocytic leukemia; MPN: myeloproliferative neoplasm; SI: splenic irradiation; Abs: antibodies; CR: complete remission; DAC: decitabine; GVHD: graft-versus-host disease; BM: bone marrow; PB: peripheral blood.