目的:自体造血细胞移植(AHCT)后血小板恢复对临床预后的影响尚待阐明。我们旨在阐明血小板恢复对临床结果的影响,血小板恢复延迟的危险因素以及每位患者血小板恢复所需的CD34+细胞剂量。
方法:使用全国性的日本注册数据库,我们回顾性分析了5222例侵袭性非霍奇金淋巴瘤(NHL)或多发性骨髓瘤(MM)患者的临床结果.
结果:在AHCT后28天的里程碑,在1102例患者中观察到血小板恢复延迟(21.1%).血小板迅速恢复与总生存率显著相关(风险比[HR]0.32,P<0.001),无进展生存期(HR0.48,P<0.001),疾病进展风险降低(HR0.66,P<0.001),非复发/非进展死亡率降低(HR0.19,P<0.001).血小板恢复延迟的不利影响似乎在NHL中更为明显。除了剂量的CD34+细胞/kg,疾病状态,两种疾病的表现状态和造血细胞移植特异性共病指数均与血小板恢复相关.然后,我们根据这些因素将患者分为三个风险组。为了在NHL中28天实现70%的血小板恢复,低,中危和高危人群需要超过2.0、3.0和4.0×106个CD34+细胞/kg,分别。在MM中,低风险组需要大约1.5×106个CD34+细胞/kg,而中危组和高危组则需要2.0和2.5×106个CD34+细胞/kg才能在28天之前达到约80%的血小板回收率.
结论:AHCT后血小板恢复延迟与较差的生存结局相关。
The prognostic impact of platelet recovery after autologous hematopoietic cell transplantation (AHCT) on clinical outcomes remains to be elucidated. We aimed to clarify the impact of platelet recovery on clinical outcomes, risk factors of delayed platelet recovery and the necessary dose of CD34+ cells for prompt platelet recovery in each patient.
Using a nationwide Japanese registry database, we retrospectively analyzed clinical outcomes of 5222 patients with aggressive non-Hodgkin lymphoma (NHL) or multiple myeloma (MM).
At a landmark of 28 days after AHCT, a delay of platelet recovery was observed in 1102 patients (21.1%). Prompt platelet recovery was significantly associated with superior overall survival (hazard ratio [HR] 0.32, P < 0.001), progression-free survival (HR 0.48, P < 0.001) and decreased risks of disease progression (HR 0.66, P < 0.001) and non-relapse/non-progression mortality (HR 0.19, P < 0.001). The adverse impacts of a delay of platelet recovery seemed to be more apparent in NHL. In addition to the dose of CD34+ cells/kg, disease status, performance status and the hematopoietic cell transplant-specific comorbidity index in both diseases were associated with platelet recovery. We then stratified the patients into three risk groups according to these factors. For the purpose of achieving 70% platelet recovery by 28 days in NHL, the low-, intermediate- and high-risk groups needed more than 2.0, 3.0 and 4.0 × 106 CD34+ cells/kg, respectively. In MM, the low-risk group needed approximately 1.5 × 106 CD34+ cells/kg, whereas the intermediate- and high-risk groups required 2.0 and 2.5 × 106 CD34+ cells/kg to achieve about 80% platelet recovery by 28 days.
A delay of platelet recovery after AHCT was associated with inferior survival outcomes.