Risk Factors Of Poor Graft Function After Allogeneic Hematopoietic Stem Cell Transplantation

Objective:To investigate the incidence,risk factors and prognosis of poor graft function(PGF)after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:The clinical data of 333 patients who received allo-HSCT in Affiliated Hospital of Guizhou Medical University from January 2014 to December 2021 were retrospectively analyzed,and they were divided into poor graft function group(n=32)and good graft function group(GGF,n=301).Chi-square test and logistic regression were used to analyze the possible influencing factors of PGF,and Kaplan-Meier survival analysis was used to compare the survival difference between the two groups.Results:In this study,the incidence of PGF after allo-HSCT was 9.6%.Multivariate analysis showed that the independent risk factors for PGF were haploidentical stem cell transplantation(Haplo-SCT)(OR=2.585,95%CI:1.163～5.742,P=0.020),low CD34~+cell count(≤5×106/L)(OR=2.330,95%CI:1.058～5.132,P=0.036)and cytomegalovirus(CMV)infection(CMV-DNA>500 copies/ml)(OR=0.341,95%CI:0.151～0.774,P=0.010).In addition,this study found that the incidence of PGF in severe aplastic anemia(SAA)was slightly higher than that in other diseases[26.23%vs(3.96%～14.29%),P=0].Univariate analysis showed that SAA was more likely to develop PGF after transplantation than acute myeloid leukemia(AML),acute lymphoblastic leukemia(ALL),and myelodysplastic syndrome(MDS)(OR=1.514,95%CI:1.158～1.98,P=0.002).SAA was a risk factor for PGF,but further multivariate analysis showed that SAA was not an independent risk factor for PGF.Kaplan-Meier survival curve showed that the 3-year overall survival(OS)and 3-year progression-free survival(PFS)of the PGF group were lower than those of the GGF group(37.5%vs 47.8%,P=0.012,25.0%vs 36.8%,P=0.031).Conclusions:The occurrence of PGF is closely related to Haplo-SCT,low dose CD34~+cells(CD34~+cells≤5×10~6/Kg)and CMV infection(CMV-DNA>500 copies/ml).SAA is a risk factor for PGF,and patients with SAA are more likely to develop PGF after transplantation than patients with AML,ALL,and MDS.