Study On The Influencing Factors Of Poor Graft Function After Allogeneic Hematopoietic Stem Cell Transplantation

Purpose1.To investigate the occurrence of poor graft function(PGF)after allogeneic hematopoietic stem cell transplantation(allo-HSCT);2.To explore the risk factors of primary PGF and secondary PGF after allo-HSCT;3.To explore the survival outcome and its risk factors of PGF patients after allo-HSCT.MethodsThe clinical data of 264 patients with hematological diseases who underwent allo-HSCT in our hospital from January 2017 to June 2019 were analyzed retrospectively.According to the diagnostic criteria of PGF,the cases were divided into PGF group and good graft function(GGF)group.The potential risk factors of sex,age,primary disease,remission state pre-transplantation,risk stratification of disease,serum ferritin,HLA matching,donor type,CD34~+cell count,cytomegalovirus(CMV)infection and graft versus-host disease(GVHD)on PGF after transplantation were analyzed.SPSS 25.0 software was used for statistical analysis.Results1.Of the 264 patients included,256(96.97%)had netrophils engraftment and243(92.05%)had platelets engraftment.The median time of netrophils and platelets engraftment was 13 days(10～25 days)and 14 days(9～34 days),respectively.A total of 47 patients(17.80%)were diagnosed as PGF,of which 4 cases(1.51%)were primary PGF,43 cases(16.29%)were secondary PGF.2.High serum ferritin before transplantation(OR=1.800,95%CI:1.021～2.330,P=0.020),low number CD34~+cells of graft(OR=0.860,95%CI:0.759～0.976,P=0.019)and CMV infection after transplantation(OR=10.775,95%CI:3.412～34.022,P=0.000)were risk factors for PGF after transplantation.3.Compared with sibling matched-identical transplantation,the incidence of PGF and the infection rate of CMV,EBV in patients with haplo-identical transplantation were significantly higher.The cumulative relapse rates of patients who underwent sibling matched-identical HSCT,haplo-identical HSCT and unrelated donor HSCT were 21.30%,11.30%and 34.30%,respectively.Compared with unrelated donor HSCT,the cumulative relapse rate after haplo-identical HSCT decreased significantly(P=0.003).4.By December 31,2020,of the 264 patients,104(39.39%)died and 160(60.61%)survived.The 4-year overall survival rate of all patients after transplantation was 58.90%(95%CI:52.43%～65.37%).The OS of PGF group(30.60%,95%CI:16.88%～44.32%)was significantly lower than that of GGF group(65.00%,95%CI:57.94%～72.06%).5.PGF(HR=1.738,95%CI:1.087～2.777,P=0.021),severe infection(HR=6.089,95%CI:3.821～9.702,P=0.000)and acute GVHD(HR=1.580,95%CI:1.055～2.368,P=0.027)were the risk factors for the decrease of OS after transplantation.Conclusions1.High serum ferritin before transplantation,low number CD34~+cells of graft and CMV infection after transplantation are the risk factors for PGF.2.Compared with HLA identical transplantation,the incidence of CMV,EBV and PGF in patients with haplo-identical HSCT were higher.However,for patients with malignant hematological disease,haplo-identical HSCT could reduce the relapse rate after transplantation.3.Post-transplant PGF,acute GVHD and severe infection are risk factors for the decrease of OS.