首页|血液病患者异基因造血干细胞移植后粒细胞植入前死亡原因分析

血液病患者异基因造血干细胞移植后粒细胞植入前死亡原因分析

Causes and characteristics of pre-engraftment mortality after allogeneic hematopoietic stem cell transplantation

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目的 分析异基因造血干细胞移植(allo-HSCT)患者粒细胞植入前死亡原因及人群特征.方法 对2016年1月至2023年7月在北京大学人民医院行allo-HSCT的全部7 427例患者进行回顾性分析.结果 7 427例患者中有56例(0.75％)在中性粒细胞植入前死亡,中位死亡时间为+7 d(-3 d～+38 d).急性白血病(AL)、重型再生障碍性贫血(SAA)、骨髓增生异常综合征(MDS)患者的中位死亡时间分别为+11 d(-1 d～+38d)、+3d(-1 d～+34d)、+16d(-1 d～38d)(P=0.013).主要死亡原因为感染(39.3％)、预处理心脏毒性(28.6％)和颅内出血(26.8％).感染是引起AL和MDS患者最常见的死亡原因(55.0％、60.0％).预处理心脏毒性所致死亡主要见于SAA患者(71.4％),而在AL患者中未见到,MDS中仅1例.53.3％的颅内出血死亡患者合并严重感染.感染、预处理心脏毒性、颅内出血引起植入前死亡的中位时间分别是+11 d(-1 d～+38d)、+2.5d(-1 d～+17d)、+8d(-3d～+37d)(P＜0.001).结论 感染是allo-HSCT患者粒细胞植入前死亡的主要原因,SAA患者应关注严重心脏毒性导致的植入前死亡.
Objective To analyze the causes and demographic characteristics of pre-engraftment mortality in patients who underwent allogeneic hematopoietic stem cell transplantation(allo-HSCT)and investigate the risk factors and measures for preventing pre-engraftment mortality.Methods A retrospective case analysis,involving a total of 7 427 patients who underwent allo-HSCT at Peking University People's Hospital between January 2016 and July 2023,was conducted.Results Among the 7 427 patients who underwent allo-HSCT,56 cases(0.75％)experienced pre-engraftment mortality.The median time to death for these 56 patients was+7(-3 to+38)days after stem cell infusion.The median times to death for patients with acute leukemia(AL),severe aplastic anemia(SAA),and myelodysplastic syndrome(MDS)were+11(-1 to+38),+3(-1 to+34),and+16(-1 to+38)days,respectively(P=0.013).The main causes of pre-engraftment mortality were infection(39.3％),cardiac toxicity(28.6％),and intracranial hemorrhage(26.8％).Infection was the most common cause of pre-engraftment mortality in patients with AL and MDS(55.0％and 60.0％),whereas cardiac toxicity was predominantly observed in patients with SAA(71.4％),with no cases in patients with AL and only one case in patients with MDS.Among patients who died from intracranial hemorrhage,53.3％had severe infections.The median times to death for infection,cardiac toxicity,and intracranial hemorrhage was+11(-1 to+38),+2.5(-1 to+17),and+8(-3 to+37)days,respectively(P＜0.001).Conclusions Infection is the primary cause of pre-engraftment mortality in allo-HSCT,and severe cardiac toxicity leading to pre-engraftment mortality should be closely monitored in patients with SAA.

Allogeneic stem cell transplantationTransplant related mortalityCause of deathInfectionCardiac toxicity

刘竞、吕萌、张圆圆、莫晓冬、孙于谦、闫晨华、王昱、许兰平、张晓辉、刘开彦、黄晓军

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北京大学人民医院,北京大学血液病研究所,国家血液系统疾病临床医学研究中心,造血干细胞移植治疗血液病北京市重点实验室,北京 100044

异基因造血干细胞移植 移植相关死亡 死亡原因 感染 心脏毒性

国家重点研发计划国家自然科学基金重大项目国家自然科学基金重点项目国家自然科学基金国家自然科学基金科技部国家重点研发计划北大医学顶尖学科及学科群发展专项

2022YFA1103300822936308193000481900173820701822021YFA110090271003Y3035

2024

10.3760/cma.j.cn121090-20231030-00240

中华血液学杂志
中华医学会

中华血液学杂志

CSTPCD北大核心
影响因子：1.17
ISSN：0253-2727
年,卷(期)：2024.45(6)