背景:异基因造血细胞移植(HCT)住院期间常发生液体超负荷(FO)。2-4级FO与100天非复发死亡率相关。1用于移植物抗宿主疾病预防的移植后环磷酰胺(PTCY)需要积极的静脉水化以预防出血性膀胱炎。
方法:这是一个单中心,回顾性,通过电子图表审查在学术医学中心进行的观察性研究。纳入的患者在第3天和第4天接受同种异体HCT,然后接受PTCY。年龄<18岁或被监禁的患者被排除在外。主要终点是2-4级FO的发生率和相关的危险因素。描述性和推断性统计(即,费希尔的精确检验,多元回归分析)。
结果:在97名筛查患者中,由于没有对FO进行分级所需的重量测量,因此包括95个,排除了2个。年龄中位数是60岁,66.3%为男性,91.6%接受了强度降低的调理,72.6%接受单倍体HCT,44.2%为ECOG0,11.6%有舒张功能障碍。2-4级FO的发生率为33.7%(n=32)。单变量分析发现年龄(连续;p=0.04)和BSA<1.7m2(p=0.006)是与2-4级FO相关的独立因素。多变量回归分析发现,年龄每增加1年,从20岁到78岁,风险增加3.3%(OR1.033,95%CI1.001,1.006;p=0.0453),BSA≥1.7m2的风险降低82.8%(OR0.172,95%CI0.051,0.588;p=0.005)。
结论:年龄增加和BSA<1.7m2是异基因HCT伴PTCY住院期间与2-4级FO相关的危险因素。
BACKGROUND: Fluid overload (FO) commonly occurs during hospitalization for allogeneic hematopoietic cell transplantation (HCT). Grade 2-4 FO is associated with day +100 non-relapse mortality.1 Post-transplant cyclophosphamide (PTCY) for graft-versus-host disease prevention requires aggressive IV hydration to prevent hemorrhagic cystitis.
METHODS: This is a single-center, retrospective, observational study conducted at an academic medical center via electronic chart review. Included patients received allogeneic HCT followed by PTCY on days +3 and +4. Patients were excluded for age < 18 years or incarceration. Primary endpoints are incidence of Grade 2-4 FO and associated risk factors. Descriptive and inferential statistics (i.e., Fisher\'s exact test, multivariable regression analysis) were used.
RESULTS: Of 97 patients screened, 95 were included and 2 were excluded due to absence of weight measurements needed to grade FO. Median age was 60 years, 66.3% were male, 91.6% received reduced-intensity conditioning, 72.6% received haploidentical HCT, 44.2% were ECOG 0, and 11.6% had diastolic dysfunction. Incidence of grade 2-4 FO was 33.7% (n = 32). Univariate analyses found age (continuous; p = 0.04) and BSA < 1.7 m2 (p = 0.006) as independent factors associated with grade 2-4 FO. Multivariable regression analysis found 3.3% higher risk with every 1-year increase in age ranging from f 20 to 78 years (OR 1.033, 95% CI 1.001, 1.006; p = 0.0453) and 82.8% lower risk with BSA ≥ 1.7 m2 (OR 0.172, 95% CI 0.051, 0.588; p = 0.005) after adjusting for co-variates.
CONCLUSIONS: Increasing age and BSA < 1.7 m2 are risk factors associated with grade 2-4 FO during hospitalization for allogeneic HCT with PTCY.