Factors influencing haematological recovery after allogeneic haemopoietic stem cell transplants: graft‐versus‐host disease, donor type, cytomegalovirus infections and cell dose
Platelet recovery after allogeneic haemopoietic stem cell transplant (HSCT) and predictive factors were analysed in 342 patients with haematological malignancies. All patients were prepared with cyclophosphamide plus total body irradiation, and received an unmanipulated HSCT from an HLA‐identical si...
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| Veröffentlicht in: | British journal of haematology 2001-01, Vol.112 (1), p.219-227 |
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| creator | Dominietto, Alida Raiola, Anna Maria Van Lint, Maria Teresa Lamparelli, Teresa Gualandi, Francesca Berisso, Giovanni Bregante, Stefania Frassoni, Francesco Casarino, Lucia Verdiani, Simonetta Bacigalupo, Andrea |
| description | Platelet recovery after allogeneic haemopoietic stem cell transplant (HSCT) and predictive factors were analysed in 342 patients with haematological malignancies. All patients were prepared with cyclophosphamide plus total body irradiation, and received an unmanipulated HSCT from an HLA‐identical sibling (n = 270), a matched unrelated donor (n = 67) or an identical twin (n = 5). The source of stem cells was peripheral blood (n = 15) or bone marrow (n = 327). Graft‐vs.‐host disease (GvHD) prophylaxis consisted of cyclosporin A with or without methotrexate. The proportion of patients with |
| doi_str_mv | 10.1046/j.1365-2141.2001.02468.x |
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In conclusion, (i) a significant proportion of allogeneic HSCT recipients are thrombocytopenic long‐term, irrespective of complete donor chimaerism, (ii) thrombocytopenia identifies patients at greater risk of lethal complications, and (iii) platelet recovery is influenced by GvHD, donor type, CMV infections and cell dose, not by stem cell source or other patient–disease‐related variables.]]></description><identifier>ISSN: 0007-1048</identifier><identifier>EISSN: 1365-2141</identifier><identifier>DOI: 10.1046/j.1365-2141.2001.02468.x</identifier><identifier>PMID: 11167808</identifier><identifier>CODEN: BJHEAL</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Science Ltd</publisher><subject>Adolescent ; Adult ; allogeneic bone marrow transplantation ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Bone Marrow Transplantation - mortality ; Bone marrow, stem cells transplantation. Graft versus host reaction ; Child ; Chimera ; Cytomegalovirus Infections - complications ; Female ; Graft vs Host Disease ; graft‐versus‐host disease ; haematopoietic recovery ; Hematologic Neoplasms - blood ; Hematologic Neoplasms - mortality ; Hematologic Neoplasms - surgery ; Hematology ; Hematopoietic Stem Cell Transplantation - mortality ; Histocompatibility Testing ; Humans ; Male ; Medical sciences ; Middle Aged ; Platelet Count ; Prognosis ; Thrombocytopenia - complications ; Time Factors ; Tissue Donors ; Transfusions. Complications. Transfusion reactions. Cell and gene therapy ; Transplantation, Homologous ; Twins, Monozygotic</subject><ispartof>British journal of haematology, 2001-01, Vol.112 (1), p.219-227</ispartof><rights>2001 INIST-CNRS</rights><rights>Copyright Blackwell Scientific Publications Ltd. Jan 2001</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4708-4bd56ff29087ede4518faf12c0f56b9a0ed5a97add68ccc453cb70d48d4c6b883</citedby><cites>FETCH-LOGICAL-c4708-4bd56ff29087ede4518faf12c0f56b9a0ed5a97add68ccc453cb70d48d4c6b883</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1046%2Fj.1365-2141.2001.02468.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1046%2Fj.1365-2141.2001.02468.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,1433,4024,27923,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=961626$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11167808$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dominietto, Alida</creatorcontrib><creatorcontrib>Raiola, Anna Maria</creatorcontrib><creatorcontrib>Van Lint, Maria Teresa</creatorcontrib><creatorcontrib>Lamparelli, Teresa</creatorcontrib><creatorcontrib>Gualandi, Francesca</creatorcontrib><creatorcontrib>Berisso, Giovanni</creatorcontrib><creatorcontrib>Bregante, Stefania</creatorcontrib><creatorcontrib>Frassoni, Francesco</creatorcontrib><creatorcontrib>Casarino, Lucia</creatorcontrib><creatorcontrib>Verdiani, Simonetta</creatorcontrib><creatorcontrib>Bacigalupo, Andrea</creatorcontrib><title>Factors influencing haematological recovery after allogeneic haemopoietic stem cell transplants: graft‐versus‐host disease, donor type, cytomegalovirus infections and cell dose</title><title>British journal of haematology</title><addtitle>Br J Haematol</addtitle><description><![CDATA[Platelet recovery after allogeneic haemopoietic stem cell transplant (HSCT) and predictive factors were analysed in 342 patients with haematological malignancies. All patients were prepared with cyclophosphamide plus total body irradiation, and received an unmanipulated HSCT from an HLA‐identical sibling (n = 270), a matched unrelated donor (n = 67) or an identical twin (n = 5). The source of stem cells was peripheral blood (n = 15) or bone marrow (n = 327). Graft‐vs.‐host disease (GvHD) prophylaxis consisted of cyclosporin A with or without methotrexate. The proportion of patients with < 50 × 109/l platelets on d +50, d +100, d +200 and d +365 after HSCT was 26%, 27%, 14% and 11% respectively. Thrombocytopenia was independent of the degree of complete donor chimaerism. Four variables were predictive of platelet recovery: donor type, acute GvHD, cytomegalovirus (CMV) infection and number of cells infused at transplant. Recipients of an unrelated graft had lower platelet counts (49 × 109/l) on d +50 than identical sibling grafts (108 × 109/l) (P < 0·001) and twin grafts (149 × 109/l) (P < 0·001). Patients with GvHD grades 0, I, II, III and IV had significantly different platelet counts on d +50 (153 × 109/l, 102 × 109/l, 85 × 109/l, 32 × 109/l and 22 × 109/l; P < 0·001) and thereafter. Thrombocytopenia was more frequent in patients with high‐level CMV antigenaemia (> four positive cells/2 × 105) (P < 0·0001) and in patients who received a low cell dose at transplant (≤ 4·1 × 108/kg) (P = 0·009). Platelet counts predicted transplant‐related mortality (TRM) and were higher at all time intervals in patients surviving the transplant. Patients with grade II GvHD and > 50 × 109/l platelets had a lower TRM than patients with grade II GvHD and ≤ 50 × 109/l platelets (14% vs. 40%, P < 0·0001).
In conclusion, (i) a significant proportion of allogeneic HSCT recipients are thrombocytopenic long‐term, irrespective of complete donor chimaerism, (ii) thrombocytopenia identifies patients at greater risk of lethal complications, and (iii) platelet recovery is influenced by GvHD, donor type, CMV infections and cell dose, not by stem cell source or other patient–disease‐related variables.]]></description><subject>Adolescent</subject><subject>Adult</subject><subject>allogeneic bone marrow transplantation</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Bone Marrow Transplantation - mortality</subject><subject>Bone marrow, stem cells transplantation. Graft versus host reaction</subject><subject>Child</subject><subject>Chimera</subject><subject>Cytomegalovirus Infections - complications</subject><subject>Female</subject><subject>Graft vs Host Disease</subject><subject>graft‐versus‐host disease</subject><subject>haematopoietic recovery</subject><subject>Hematologic Neoplasms - blood</subject><subject>Hematologic Neoplasms - mortality</subject><subject>Hematologic Neoplasms - surgery</subject><subject>Hematology</subject><subject>Hematopoietic Stem Cell Transplantation - mortality</subject><subject>Histocompatibility Testing</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Platelet Count</subject><subject>Prognosis</subject><subject>Thrombocytopenia - complications</subject><subject>Time Factors</subject><subject>Tissue Donors</subject><subject>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><subject>Transplantation, Homologous</subject><subject>Twins, Monozygotic</subject><issn>0007-1048</issn><issn>1365-2141</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkc1u1DAURiMEokPhFZAFEitmsPPjOEgsaEUpqBIbWFuOfTP1KLGDr1OaXR-Bh-GJeBKcmVGRWLHytXy-6086WUYY3TBa8je7DSt4tc5ZyTY5pWxD85KLze2DbHX_8DBbUUrrdQqIk-wJ4i6BBa3Y4-yEMcZrQcUq-3WhdPQBiXVdP4HT1m3JtYJBRd_7rdWqJwG0v4EwE9VFCET16QEcWL0H_egtxHTBCAPR0PckBuVw7JWL-JZsQ4r9vvuZNuCEabj2GImxCArhNTHe-UDiPKZZz9EPsFW9v7Fh2ncCHa13SJQzh93GIzzNHnWqR3h2PE-zbxcfvp5frq--fPx0_v5qrcuainXZmop3Xd5QUYOBsmKiUx3LNe0q3jaKgqlUUytjuNBal1Wh25qaUphS81aI4jR7ddg7Bv99AoxysLi0UA78hLKmPOd5wRP44h9w56fgUjfJGlE1TVXlCRIHSAePGKCTY7CDCrNkVC5a5U4u9uRiTy5a5V6rvE3R58f9UzuA-Rs8ekzAyyOgMCnrkgBt8Z5rOEtNE_XuQP2wPcz__b08-3y5TMUfMkTFFg</recordid><startdate>200101</startdate><enddate>200101</enddate><creator>Dominietto, Alida</creator><creator>Raiola, Anna Maria</creator><creator>Van Lint, Maria Teresa</creator><creator>Lamparelli, Teresa</creator><creator>Gualandi, Francesca</creator><creator>Berisso, Giovanni</creator><creator>Bregante, Stefania</creator><creator>Frassoni, Francesco</creator><creator>Casarino, Lucia</creator><creator>Verdiani, Simonetta</creator><creator>Bacigalupo, Andrea</creator><general>Blackwell Science Ltd</general><general>Blackwell</general><general>Blackwell Publishing Ltd</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>200101</creationdate><title>Factors influencing haematological recovery after allogeneic haemopoietic stem cell transplants: graft‐versus‐host disease, donor type, cytomegalovirus infections and cell dose</title><author>Dominietto, Alida ; Raiola, Anna Maria ; Van Lint, Maria Teresa ; Lamparelli, Teresa ; Gualandi, Francesca ; Berisso, Giovanni ; Bregante, Stefania ; Frassoni, Francesco ; Casarino, Lucia ; Verdiani, Simonetta ; Bacigalupo, Andrea</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4708-4bd56ff29087ede4518faf12c0f56b9a0ed5a97add68ccc453cb70d48d4c6b883</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>allogeneic bone marrow transplantation</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Bone Marrow Transplantation - mortality</topic><topic>Bone marrow, stem cells transplantation. Graft versus host reaction</topic><topic>Child</topic><topic>Chimera</topic><topic>Cytomegalovirus Infections - complications</topic><topic>Female</topic><topic>Graft vs Host Disease</topic><topic>graft‐versus‐host disease</topic><topic>haematopoietic recovery</topic><topic>Hematologic Neoplasms - blood</topic><topic>Hematologic Neoplasms - mortality</topic><topic>Hematologic Neoplasms - surgery</topic><topic>Hematology</topic><topic>Hematopoietic Stem Cell Transplantation - mortality</topic><topic>Histocompatibility Testing</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Platelet Count</topic><topic>Prognosis</topic><topic>Thrombocytopenia - complications</topic><topic>Time Factors</topic><topic>Tissue Donors</topic><topic>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</topic><topic>Transplantation, Homologous</topic><topic>Twins, Monozygotic</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dominietto, Alida</creatorcontrib><creatorcontrib>Raiola, Anna Maria</creatorcontrib><creatorcontrib>Van Lint, Maria Teresa</creatorcontrib><creatorcontrib>Lamparelli, Teresa</creatorcontrib><creatorcontrib>Gualandi, Francesca</creatorcontrib><creatorcontrib>Berisso, Giovanni</creatorcontrib><creatorcontrib>Bregante, Stefania</creatorcontrib><creatorcontrib>Frassoni, Francesco</creatorcontrib><creatorcontrib>Casarino, Lucia</creatorcontrib><creatorcontrib>Verdiani, Simonetta</creatorcontrib><creatorcontrib>Bacigalupo, Andrea</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of haematology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dominietto, Alida</au><au>Raiola, Anna Maria</au><au>Van Lint, Maria Teresa</au><au>Lamparelli, Teresa</au><au>Gualandi, Francesca</au><au>Berisso, Giovanni</au><au>Bregante, Stefania</au><au>Frassoni, Francesco</au><au>Casarino, Lucia</au><au>Verdiani, Simonetta</au><au>Bacigalupo, Andrea</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors influencing haematological recovery after allogeneic haemopoietic stem cell transplants: graft‐versus‐host disease, donor type, cytomegalovirus infections and cell dose</atitle><jtitle>British journal of haematology</jtitle><addtitle>Br J Haematol</addtitle><date>2001-01</date><risdate>2001</risdate><volume>112</volume><issue>1</issue><spage>219</spage><epage>227</epage><pages>219-227</pages><issn>0007-1048</issn><eissn>1365-2141</eissn><coden>BJHEAL</coden><abstract><![CDATA[Platelet recovery after allogeneic haemopoietic stem cell transplant (HSCT) and predictive factors were analysed in 342 patients with haematological malignancies. All patients were prepared with cyclophosphamide plus total body irradiation, and received an unmanipulated HSCT from an HLA‐identical sibling (n = 270), a matched unrelated donor (n = 67) or an identical twin (n = 5). The source of stem cells was peripheral blood (n = 15) or bone marrow (n = 327). Graft‐vs.‐host disease (GvHD) prophylaxis consisted of cyclosporin A with or without methotrexate. The proportion of patients with < 50 × 109/l platelets on d +50, d +100, d +200 and d +365 after HSCT was 26%, 27%, 14% and 11% respectively. Thrombocytopenia was independent of the degree of complete donor chimaerism. Four variables were predictive of platelet recovery: donor type, acute GvHD, cytomegalovirus (CMV) infection and number of cells infused at transplant. Recipients of an unrelated graft had lower platelet counts (49 × 109/l) on d +50 than identical sibling grafts (108 × 109/l) (P < 0·001) and twin grafts (149 × 109/l) (P < 0·001). Patients with GvHD grades 0, I, II, III and IV had significantly different platelet counts on d +50 (153 × 109/l, 102 × 109/l, 85 × 109/l, 32 × 109/l and 22 × 109/l; P < 0·001) and thereafter. Thrombocytopenia was more frequent in patients with high‐level CMV antigenaemia (> four positive cells/2 × 105) (P < 0·0001) and in patients who received a low cell dose at transplant (≤ 4·1 × 108/kg) (P = 0·009). Platelet counts predicted transplant‐related mortality (TRM) and were higher at all time intervals in patients surviving the transplant. Patients with grade II GvHD and > 50 × 109/l platelets had a lower TRM than patients with grade II GvHD and ≤ 50 × 109/l platelets (14% vs. 40%, P < 0·0001).
In conclusion, (i) a significant proportion of allogeneic HSCT recipients are thrombocytopenic long‐term, irrespective of complete donor chimaerism, (ii) thrombocytopenia identifies patients at greater risk of lethal complications, and (iii) platelet recovery is influenced by GvHD, donor type, CMV infections and cell dose, not by stem cell source or other patient–disease‐related variables.]]></abstract><cop>Oxford, UK</cop><pub>Blackwell Science Ltd</pub><pmid>11167808</pmid><doi>10.1046/j.1365-2141.2001.02468.x</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | British journal of haematology, 2001-01, Vol.112 (1), p.219-227 |
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| subjects | Adolescent Adult allogeneic bone marrow transplantation Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Bone Marrow Transplantation - mortality Bone marrow, stem cells transplantation. Graft versus host reaction Child Chimera Cytomegalovirus Infections - complications Female Graft vs Host Disease graft‐versus‐host disease haematopoietic recovery Hematologic Neoplasms - blood Hematologic Neoplasms - mortality Hematologic Neoplasms - surgery Hematology Hematopoietic Stem Cell Transplantation - mortality Histocompatibility Testing Humans Male Medical sciences Middle Aged Platelet Count Prognosis Thrombocytopenia - complications Time Factors Tissue Donors Transfusions. Complications. Transfusion reactions. Cell and gene therapy Transplantation, Homologous Twins, Monozygotic |
| title | Factors influencing haematological recovery after allogeneic haemopoietic stem cell transplants: graft‐versus‐host disease, donor type, cytomegalovirus infections and cell dose |
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