Risk factors for lymphoproliferative disorders after allogeneic hematopoietic stem cell transplantation in chil-dren with thalassemia major
Objective To explore the risk factors for lymphoproliferative disorders(PTLD)in children with thalassemia major(TM)after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods This was a retrospective case-control study.A total of 482 children with TM who underwent allo-HSCT at Shenzhen Children's Hospital between January 2020 and December 2022 were selected and classified into the PTLD and non-PTLD groups according to the occurrence of PTLD.The risk factors for PTLD after allo-HSCT in children with TM were analyzed,and the diagnostic efficiency of relevant risk factors for PTLD was analyzed by receiver operating characteristic(ROC)curve.Results A total of 25 out of 482 patients(5.2％,25/482)developed PTLD about 114(54-271)days after allo-HSCT.Among them,12 cases(12/25,48.0％)occurred within 100 days,and 22 cases(22/25,88.0％)occurred within 1 year after allo-HSCT.Univariate analysis showed that there were significant differences in gender composition,type of transplant donor,number of natural killer cells and B lymphocytes in peripheral blood at 30 days after allo-HSCT,positive rate of plasma Epstein-Barr virus deoxyribonucleic acid(EBV-DNA)and incidence rate of acute graft-versus-host disease(aGVHD)between the 2 groups(all P＜0.05).Multivariate Logistic regression analysis showed that female(OR=3.196,95％CI:1.144-8.929),positive plasma EBV-DNA(OR=17.523,95％CI:5.449-56.344)and aGVHD(OR=3.156,95％CI:1.161-8.575)were independent risk factors for PTLD after allo-HSCT in TM children(all P＜0.05).The ROC curve analysis showed that positive plasma EBV-DNA had an excellent accuracy in predicting the occurrence of PTLD after allo-HSCT(sensitivity was 0.796,specificity was 0.800,area under the curve was 0.803).If combined with aGVHD and gender,the area under the curve for the prediction of PTLD increased to 0.831.Conclusions Female,positive plasma EBV-DNA and aGVHD are independent risk factors for PTLD after allo-HSCT in children with TM.It provides useful early warnings for the prediction and prevention of PTLD.
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