Causes and characteristics of pre-engraftment mortality after allogeneic hematopoietic stem cell transplantation
10.3760/cma.j.cn121090-20231030-00240
- VernacularTitle: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
- Author:
Jing LIU
1
;
Meng LYU
;
Yuanyuan ZHANG
;
Xiaodong MO
;
Yuqian SUN
;
Chenhua YAN
;
Yu WANG
;
Lanping XU
;
Xiaohui ZHANG
;
Kaiyan LIU
;
Xiaojun HUANG
Author Information
1. 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
- Keywords:
Allogeneic stem cell transplantation;
Transplant related mortality;
Cause of death;
Infection;
Cardiac toxicity
- From:
Chinese Journal of Hematology
2024;45(6):542-548
- CountryChina
- Language:Chinese
-
Abstract:
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.
