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A high transfusion burden following an ambulatory-allogeneic hematopoietic cell transplantation using reduced-intensity conditioning is associated with adverse outcomes
Jaime-Pérez, J. C., Hernández-Coronado, M., Salazar-Cavazos, L., Marfil-Rivera, L. J., Gómez-Almaguer, D.
Blood cells, molecules & diseases. 2021;88:102537
Abstract
OBJECTIVES Ambulatory allogeneic hematopoietic cell transplantation (allo-HCT) after reduced-intensity conditioning (RIC) is a cost-effective option for hematology patients. Data on the impact of transfusion burden in this setting are scarce; we analyzed this retrospectively. METHODS A study of 177 HLA-identical and haploidentical allo-HCT recipients on an outpatient basis was conducted between 2013 and 2019. Packed red blood cell (PRBC) and platelet transfusions were documented from days 0-100 after HCT. RESULTS A total of 121 patients (68.4%) required transfusion while 56 (31.6%) did not. In the multivariate analysis, a lower disease-free (DFS) and overall survival (OS) were documented for patients that received =9 total blood products (p = 0.018) (p = 0.014), those who required hospitalization (p = 0.001) (p < 0.001), had acute graft-versus-host disease (p = 0.016) (p = 0.004), and a high/very high Disease-Risk-Index (p = 0.002; p = 0.004), respectively. Transfusion of =5 PRBC units was associated with a lower OS (p = 0.027). The cumulative incidence of transplant-related mortality at two years for an HLA-identical transplant was 9.5% and for haploidentical, it was 27.1% (p = 0.027); this last group had significantly more transfusion demands than HLA-identical recipients (p = 0.029). CONCLUSION Increased blood product utilization is an independent predictor of decreased survival in ambulatory RIC allo-HCT recipients. Further evidence leading to individualized guidelines to transfuse in this complex scenario is needed.
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Combination treatment of rituximab and donor platelets infusion to reduce donor-specific anti-HLA antibodies for stem cells engraftment in haploidentical transplantation
Zhang, R., He, Y., Yang, D., Jiang, E., Ma, Q., Pang, A., Zhai, W., Wei, J., Feng, S., Han, M.
Journal of clinical laboratory analysis. 2020;:e23261
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Abstract
BACKGROUND Donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) in recipients is a risk factor for donor stem cell graft failure in haploidentical hematopoietic stem cell transplantation (haplo-HSCT), and the treatment to reduce the levels of DSAs is not unanimous. This study was to analysis the role of DSAs for stem cell engraftment and to discuss the effective treatment to reduce DSAs in haplo-HSCT. METHODS We retrospectively evaluated the levels of DSAs and the effect of the combination treatment of rituximab and donor platelets (PLTs) for donor stem cell engraftment in haplo-HSCT patients from June 2016 to March 2018 at our center. RESULTS Nine patients (11.5%) out of the total 78 patients were DSAs-positive and multivariate analysis revealed DSAs was the only factor that affected engraftment. Seven out of the 9 DSAs (+) patients received therapy: Four had antibodies against donor HLA class I (HLA-I) antigens and were administered two therapeutic amounts of donor apheresis platelets (platelet count approximately 3-5 x 10(11) ) before donor stem cell infusion and the other three patients received a combination therapy of donor apheresis platelets and rituximab due to the antibodies against both donor HLA-I antigens and HLA class II (HLA-II) antigens. All the seven patients achieved donor stem cell engraftment successfully, and the DSAs levels decreased rapidly after transplantation. CONCLUSIONS DSAs is an important factor affecting engraftment in haplo-HSCT. Donor platelet transfusion is one simple and effective treatment for HLA-I DSAs, and a combination therapy should be administered if patients have both HLA-I and HLA-II antibodies.
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Impact Of Pre-Emptive Granulocyte Infusions During Febrile Neutropenia In Patients Colonized With Carbapenem Resistant Gram-Negative Bacteria Undergoing Haploidentical Transplantation
Jaiswal, S. R., Bhakuni, P., Bhagwati, G., Joy, A., Chakrabarti, A., Chakrabarti, S.
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019
Abstract
BACKGROUND AND METHODS We prospectively studied the impact of preemptive granulocyte infusions (pGI) in 69 patients colonized with carbapenem-resistant gram-negative bacteria (CRGNB) undergoing Haploidentical HCT, compared to a previous cohort of 33 patients who received only antimicrobials directed towards CRGNB at the onset of neutropenic fever (non-pGI group). RESULTS All patients developed neutropenic fever at a median of day +8 (range -4 to +12) after transplantation. Engraftment kinetics were similar for both groups. The median number of granulocyte infusion was 2 (range,1-7) and the median dose of granulocytes infused was 5x10(10) (range,1-30) granulocytes/infusion. The overall incidence of CRGNB blood-stream infections (BSI) was 21.2% in non-pGI group (7/33) and 17.5% (12/69), in the pGI group (p=0.8). However, the CRGNB related mortality amongst those with BSI was 100% (7/7) in non-PGI group vs 16.6% (2/12) in the PGI group (p=0.001). The day 100 (4.4% vs 24.4%, p=0.002) and 2- year non-relapse mortality (NRM) (7.5% vs 35.6%, p=0.0001) were significantly reduced in the pGI group. The overall survival at 2 years was 75.6% in the pGI group vs 21.2% in the non-PGI group (p=0.0001). CONCLUSIONS Colonization and subsequent BSI with CRGNB is associated with a high incidence of mortality in patients undergoing HCT. Pre-emptive granulocyte infusion reduced early mortality associated with CRGNB in the colonized patients undergoing PTCy based Haploidentical HCT.
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RBC and platelet transfusion support in the first 30 and 100 days after haploidentical hematopoietic stem cell transplantation
Yuan, S., Yang, D., Nakamura, R., Zhuang, L., Al Malki, M. M., Wang, S.
Transfusion. 2019
Abstract
BACKGROUND The volume of haploidentical hematopoietic stem cell transplant (haplo-HSCT) has increased dramatically in recent years. However, the associated higher risk of delayed engraftment may increase patient transfusion requirements. STUDY DESIGN AND METHODS The post-HSCT RBC and platelet transfusions of 195 haplo-HSCT recipients were evaluated. Patient and transplant-related factors potentially impacting the number of products transfused and time to transfusion independence were assessed. RESULTS Nearly all (98.4%) patients were transfused in the first 30 days, and 59.2% were transfused between days 31 and 100. Among the transfused patients, medians of 5 units (interquartile range [IQR] = 3-8) of RBCs and 11 units (6-20) platelets were given in the first 30 days, and medians of 3 units (IQR = 1-7) of RBCs and 6 units (2-18) of platelets were transfused between days 31 and 100. Median times for achieving RBC and platelet transfusion independence were 34 (95% CI: 28-40) and 25 (95% CI: 23-27) days, respectively. Multivariable analyses showed that RBC transfusions in the 10 days before HSCT were associated with significantly increased and sustained RBC and platelet transfusion requirements. Major ABO incompatibility led to increased RBC transfusions. Advanced disease was associated with increased transfusions during the first 30 days, whereas GVHD increased platelet transfusions between days 31 and 100. Effects of age, sex, CD34+ cell dose, stem cell source, and conditioning regimen were limited or insignificant. CONCLUSIONS This study for the first time provided quantitative transfusion data on a large cohort of haplo-HSCT recipients and identified factors predictive of increased transfusions.