Incidence, Risk Factors, and Outcomes of Primary Poor Graft Function after Allogeneic Hematopoietic Stem Cell Transplantation

Yanmin Zhao; Fei Gao; Jimin Shi; Yi Luo; Yamin Tan; Xiaoyu Lai; Jian Yu; He Huang

doi:10.1016/j.bbmt.2019.05.036

Incidence, Risk Factors, and Outcomes of Primary Poor Graft Function after Allogeneic Hematopoietic Stem Cell Transplantation

Biol Blood Marrow Transplant. 2019 Sep;25(9):1898-1907. doi: 10.1016/j.bbmt.2019.05.036. Epub 2019 Jun 6.

Authors

Yanmin Zhao¹, Fei Gao¹, Jimin Shi¹, Yi Luo¹, Yamin Tan¹, Xiaoyu Lai¹, Jian Yu¹, He Huang²

Affiliations

¹ Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China; Zhejiang Engineering Laboratory for Stem Cell and Immunotherapy, Hangzhou, Zhejiang, China.
² Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China; Zhejiang Engineering Laboratory for Stem Cell and Immunotherapy, Hangzhou, Zhejiang, China. Electronic address: huanghe@zju.edu.cn.

PMID: 31176790
DOI: 10.1016/j.bbmt.2019.05.036

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative therapy for both malignant and nonmalignant hematologic disorders. However, primary poor graft function (PGF) is a serious early complication of allo-HSCT that leads to a poor outcome. Little is known about the characteristics, incidence, and risk factors of primary PGF occurring after allo-HSCT. Here we performed a 1:4 ratio nested case-control study in 830 patients who underwent allo-HSCT between April 2013 and November 2018 at our center. Twenty-four patients (14 males and 10 females; average age, 35.79 years; range, 17 to 53 years) developed primary PGF. On univariate and multivariate analyses, a CD34⁺ cell dose <5 × 10⁶/kg (P = .003), a serum ferritin (SF) level >2000 ng/mL (P = .008), and splenomegaly (P = .039) were identified as 3 independent risk factors for primary PGF. After a median follow-up of 7.5 months (range, 1 to 48 months), only 5 patients (20.8%) survived. The survival rate of patients with primary PGF was significantly lower than that of patients with good graft function (GGF) (1-year overall survival, 25.0% versus 90.6%; P < .001). Cox regression analysis suggested that PGF and high SF level were strongly associated with rapid death in these patients. In conclusion, allo-HSCT recipients with a low CD34⁺ cell dose in their graft and exhibiting a high SF level and splenomegaly should be monitored for the development of primary PGF after allo-HSCT, and effective therapies need to be explored.

Keywords: Allogeneic stem cell transplantation; Poor graft function; Risk factors.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Allografts
Case-Control Studies
Disease-Free Survival
Female
Graft Survival*
Hematologic Neoplasms* / mortality
Hematologic Neoplasms* / therapy
Hematopoietic Stem Cell Transplantation*
Humans
Incidence
Male
Middle Aged
Risk Factors
Survival Rate