Objective: To investigate the predictive indexes of blood transfusion after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with blood diseases.
Methods: From January 2018 to December 2022, 188 patients with blood diseases who underwent allo-HSCT in our hospital were enrolled, and divided into non-transfusion group (104 cases) and transfusion group (84 cases). Gender, age, preconditioning regimens, granulocyte and platelet implantation time, donor and recipient relationship, human leucocyte antigen (HLA) compatibility, blood type compatibility, red blood cell (RBC), hemoglobin (Hb), and platelet (PLT) before transplantation, the number of peripheral hematopoietic stem cells, mononuclear cells (MNCs), total nucleated cells (TNCs), and CD34+ cells, RBC, PLT, and plasma transfusions before and during transplantation, as well as the occurrence of cytomegalovirus (CMV), Epstein-Barr virus, nephritis, pulmonary infection and graft-versus-host disease (GVHD) after transplantation were collected in the two groups. Univariate and multivariate analysis of the above data affecting post-transplantation blood transfusion were performed. ROC curve was used to analyze the diagnostic efficacy of post-transplantation blood transfusion.
Results: The RBC count in the non-transfusion group before transplantation was 2.60(2.27, 3.14)×1012/L, which was significantly higher than 2.43(2.11, 2.82)×1012/L in the transfusion group (P<0.05). During transplantation, the RBCs infusion was 3.50(1.00, 5.50) U and the PLT (therapeutic volume) infusion was 3.00(1.80, 4.95) in the non-transfusion group, which were lower than 4.25(2.00, 8.00) U and 4.00(2.60, 6.80) in the transfusion group (both P<0.05). The incidence of pulmonary infection and GVHD was 38.46% and 29.81% in the non-transfusion, respectively, which was lower than 53.57% and 45.24% in the transfusion group in the late post transplantation period (both P<0.05). CD34+ cell content (OR =0.851, 95%CI: 0.744-0.970, P<0.05) was an independent protective factor for post-transplantation blood transfusion, while GVHD (OR =1.986, 95%CI: 1.077-3.660, P<0.05) was an independent risk factor. The diagnostic efficacy of CD34+ cells alone (AUC=0.578, 95%CI: 0.497-0.660, P>0.05) or GVHD alone (AUC=0.577, 95%CI: 0.495-0.660, P>0.05) for blood transfusion was poor, while their combination (AUC=0.629, 95%CI: 0.550-0.710, P<0.05) significantly improved the diagnostic efficacy compared to a single indicator.
Conclusion: Graft CD34+ cell content is an independent protective factor for blood transfusion after allo-HSCT in patients with blood diseases, while GVHD is an independent risk factor. It is of clinical significance to combine the two indexes to predict the blood transfusion strategy after transplantation.
题目: 血液病患者异基因造血干细胞移植后输血预测指标探索.
目的: 探索血液病患者异基因造血干细胞移植（allo-HSCT）后的输血预测指标.
方法: 纳入2018年1月至2022年12月在本院行allo-HSCT的血液病患者188例，分为移植后未输血组104例、输血组84例。收集两组患者性别、年龄、预处理方案、粒系和血小板植活时间、供受者亲缘关系、HLA相合度、血型相合度，移植前RBC、Hb和PLT，外周造血干细胞量、MNC、TNC、CD34+细胞数，移植前期和移植期RBC、PLT、血浆输注情况，移植后巨细胞病毒、EB病毒、肾炎、肺部感染、GVHD发生情况。对以上资料进行影响移植后输血的单因素分析和多因素分析，采用ROC曲线进行移植后期输血诊断效能分析.
结果: 未输血组移植前RBC计数为2.60（2.27，3.14）×1012/L，显著高于输血组的2.43（2.11，2.82）×1012/L（P<0.05）；移植期间未输血组输注红细胞3.50（1.00，5.50）U、血小板3.00（1.80，4.95）治疗量，低于输血组输注的红细胞4.25（2.00，8.00）U、血小板4.00（2.60，6.80）治疗量（均P<0.05）；移植后期未输血组肺部感染和GVHD的发生率分别为38.46%、29.81%，低于输血组的53.57%、45.24%（均P<0.05）。CD34+细胞（OR =0.851，95%CI：0.744-0.970，P<0.05）是移植后输血的独立保护因素，而GVHD（OR =1.986，95%CI：1.077-3.660，P<0.05）是移植后输血的独立危险因素。单独使用CD34+细胞（AUC=0.578，95%CI：0.497-0.660，P>0.05）或GVHD（AUC=0.577，95%CI：0.495-0.660，P>0.05）诊断输血效能均较差，而联合应用CD34+细胞和GVHD（AUC=0.629，95%CI：0.550-0.710，P<0.05）较单一指标的诊断效能显著提高.
结论: 移植物CD34+细胞含量是血液病患者allo-HSCT后期输血的独立保护因素，GVHD是移植术后输血的危险因素，联合应用两项指标预测患者移植后期的用血方案具有临床意义.
Keywords: allogeneic hematopoietic stem cell transplantation; blood transfusion; graft-versus-host disease; CD34+ cell.