The effect of glucose-6-phosphate dehydrogenase deficiency on allogeneic hematopoietic stem cell transplantation in patients with hematological disorders
Objectives To determine the effect of glucose-6-phosphate-dehydrogenase(G6PD)deficiency on patients'complications and prognosis following allogeneic stem cell hematopoietic transplantation(allo-HSCT).Methods 7 patients with G6PD deficiency(study group)who underwent allo-HSCT at Peking University People's Hospital from March 2015 to January 2021 were selected as the study group,and thirty-five patients who underwent allo-HSCT during the same period but did not have G6PD deficiency were randomly selected as the control group in a 1:5 ratio.Gender,age,underlying diseases,and donors were balanced between the two groups.Collect clinical data from two patient groups and perform a retrospective nested case-control study.Results The study group consisted of six male patients and one female patient,with a median age of 37(range,2-45)years old.The underlying hematologic diseases included acute myeloid leukemia(n=3),acute lymphocytic leukemia(n=2),and severe aplastic anemia(n=2).All 7 G6PD deficiency patients achieved engraftment of neutrophils within 28 days of allo-HSCT,while the engraftment rate of neutrophils was 94.5%in the control group.The median days of platelet engraftment were 21(6-64)d and 14(7-70)d(P=0.113).The incidence rates of secondary poor graft function in the study group and control group were 42.9%(3/7)and 8.6%(3/35),respectively(P=0.036).The CMV infection rates were 71.4%(5/7)and 31.4%(11/35),respectively(P=0.049).The incidence rates of hemorrhagic cystitis were 57.1%(4/7)and 8.6%(3/35),respectively(P=0.005),while the bacterial infection rates were 100%(7/7)and 77.1%(27/35),respectively(P=0.070).The infection rates of EBV were 14.3%(1/7)and 14.3%(5/35),respectively(P=1.000),while the incidence of fungal infection was 14.3%(1/7)and 25.7%(9/35),respectively(P=0.497).The rates of post-transplant lymphoproliferative disease(PTLD)were 0%and 5.7%,respectively(P=0.387).Conclusions The findings of this study indicate that blood disease patients with G6PD deficiency can tolerate conventional allo-HSCT pretreatment regimens,and granulocytes and platelets can be implanted successfully.However,after transplantation,patients should exercise caution to avoid viral infection,complications of hemorrhagic cystitis,and secondary poor graft function.