Pretransplant Minimal Pleural and Peritoneal Effusion Is a Potential Poor Prognostic Indicator in Allogeneic Hematopoietic Stem Cell Transplantation

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-01-06 DOI:10.1111/ctr.70072

Takashi Oyama, Akira Honda, Yasutaka Masuda, Ken Morita, Hiroaki Maki, Yosuke Masamoto, Mineo Kurokawa

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Abstract

Background

Pleural effusion and ascites developing after allogeneic hematopoietic stem cell transplantation (allo-SCT) are generally associated with inferior overall survival (OS); however, the prognostic value of pretransplant effusion on transplant outcomes remained unclear.

Methods

We retrospectively evaluated minimal pleural effusion and ascites detected by computed tomography in 248 consecutive adult patients who underwent their first allo-SCT from January 2007 to December 2022.

Results

Forty-eight patients demonstrated minimal pleural effusion or ascites within 100 days before transplantation (Effusion group) and the other 200 had no effusion (No effusion group). Serum albumin level was significantly lower in the Effusion group than in the No effusion group (median 3.8 vs. 3.4 g/dL, p < 0.001). Performance status (PS) was significantly inferior and refined disease risk index tended to be higher in the Effusion group. The 2-year OS rate after transplantation was significantly worse in the Effusion group (57.1% vs. 36.7%, p < 0.001). The Effusion group had a significantly lower cumulative incidence of neutrophil and platelet engraftment and higher hepatic veno-occlusive disease. Moreover, a tendency toward higher cumulative incidence of relapse and non-relapse mortality was shown in the Effusion group. In multivariate analysis, the Effusion group had a significantly inferior OS with a hazard ratio of 1.848 (95% confidence interval 1.231–2.774), even after adjustment for disease risk, serum albumin level, PS, and Hematopoietic Cell Transplant-Comorbidity Index points.

Conclusion

Reflecting high disease activity and impaired general condition, pretransplant effusion can be a complementary indicator for poor prognosis in allo-SCT.

Abstract Image

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移植前微量胸膜和腹膜积液是异基因造血干细胞移植的潜在不良预后指标。

背景：同种异体造血干细胞移植（allogene hematopoietic stem cell transplantation, alloo - sct）后发生胸腔积液和腹水通常与较差的总生存期（OS）相关；然而，移植前积液对移植预后的预后价值尚不清楚。方法：我们回顾性评估了从2007年1月至2022年12月连续248例接受首次同种异体sct的成年患者的计算机断层扫描检测到的最小胸膜积液和腹水。结果：移植前100天出现少量胸腔积液或腹水者48例（积液组），无积液者200例（无积液组）。积液组血清白蛋白水平明显低于无积液组（中位数3.8 vs 3.4 g/dL, p < 0.001）。积液组表现状态（Performance status， PS）明显较差，精细化疾病风险指数有升高趋势。积液组移植后2年OS率明显更差（57.1% vs 36.7%, p < 0.001）。积液组中性粒细胞和血小板植入的累积发生率明显降低，肝静脉闭塞性疾病发生率较高。此外，积液组有较高的复发和非复发死亡率的趋势。在多因素分析中，即使在调整疾病风险、血清白蛋白水平、PS和造血细胞移植共病指数积分后，积液组的OS也明显低于积液组，风险比为1.848（95%可信区间为1.232 -2.774）。结论：移植前积液反映了高疾病活动性和一般状况受损，可作为异体细胞移植预后不良的补充指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.