Clinical Study About Hemorrhagic Cystitis In Non T Cell-depleted In Vitro Allogeneic Hematopoietic Stem Cell Transplantation

Objective:To explore the riskfactors,long-term survival and clinical treatment of HC after Allo-HSCT.Methods:A retrospective analysis of 178 consecutive patients who underwent Allo-HSCT in the Department of Hematology of our hospital from January2017 to December 2020.The patients were divided into HC group and non-HC group.The starting date of pretreatment was used as the starting point for follow-up.The 5 clinical parameters as risk factors were selected for univariate analysis and multivariate analysis:gender,age,and whether pretreatment contained ATG,a GVHD,BK virus infection.The124 haploid transplant patients were divided into MAC group and RIC group,and the cumulative incidence of HC in the MAC group and RIC group was calculated respectively.P<0.05 indicated that the difference was statistically significant;In terms of occurrence and non-occurrence,time of occurrence,severity,duration,gender,age,etc.,to study whether LOHC has a significant impact on PFS.For 5 patients with severe HC who were refractory and protracted,ADSCs were treated on the basis of basic treatment.Results:Follow-up as of March 30,2021,57 of the 178 transplant patients with HC,and the cumulative incidence of LOHC was 32.02%(95%CI,17.5%～41.7%),the onset time was+17～+163d(median time+38d),and the duration was 5～141d(medium duration18d).Both univariate analysis and multivariate analysis show that BK virus infection and the use of ATGis related to the HC.The cumulative incidence of LOHC in RIC patients was higher than that in MAC patients,but the difference was not statistically significant(P>0.05).The 2-year expected PFS of the 124 haploid transplant patients without HC was74.47%,which was slightly higher than 74.03%in the HC group,but the difference was not statistically significant;the 2-year expected PFS of patients with mild HC was 89.66%higher than that of 50.00%of patients with severe HC,and the difference between the two groups in 2-year PFS was statistically significant(P<0.05).The onset time,duration,gender,and age of HC did not show a significant effect on PFS.The differences were not statistically significant.Five patients with severe HC were treated with ADSCs.The actual infusion dose was the lowest 0.9×10~6/kg and the highest 1.4×10~6/kg.All 5 patients were cured,and all of them were effective after 3 injections.Conclusion:The occurrence of HC is mainly related to BK virus infection and the use of ATG.After haploid transplantation,HC has no significant effect on the overall PFS of patients,but the severity of HC has an effect on PFS.The duration of HC,the time of occurrence,gender and age of the patient have no effect on PFS.ADSCs have a good therapeutic effect on severe and long-lasting HC.