Graft Rejection After Ex Vivo T-Cell-Depleted Haploidentical Hematopoietic Cell Transplantation: Analysis of Incidence, Survival, Risk Factors, and Association With Biomarkers of Inflammation

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-07-01 DOI:10.1016/j.transproceed.2025.05.025

Ladislav Król , Stina Wichert , Beata Tomaszewska-Toporska , Stig Lenhoff , Cornelis Jan Pronk , Jacek Toporski , Ingrid Øra , Josefina Dykes , Dominik Turkiewicz

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引用次数: 0

Abstract

Background

Graft rejection (GR) is common complication after haploidentical hematopoietic cell transplantation (haplo-HCT). There are only a few studies describing the clinical presentation and potential risk factors of GR, and the optimal rescue strategy is not established.

Objectives

To evaluate the cumulative incidence and potential risk factors for GR following haplo-HCT, and to compare survival, clinical symptoms, selected inflammatory parameters, and lactate dehydrogenase levels in patients with and without GR.

Methods

A retrospective single-center study including 79 patients (59 children and 20 adults) who underwent ex vivo T-cell-depleted haplo-HCT at Skåne University Hospital from 2001 to 2020.

Results

The cumulative incidence of GR was 14.8% (95% CI: 7.1-22.6). The median time to GR was 21 days (13-31). Five-year overall survival for patients without GR was 45.3% (95% CI: 32.8-57.7), and 41.7% (95% CI: 13.8-69.9) for those with GR (P = n.s.). None of the analyzed patient- and transplant-related factors were significantly associated with GR. Macular rash was the only GR-associated symptom. Patients with GR had higher median ferritin (18,096 µg/L; 1412-95,980) and lactate dehydrogenase (10.5 µkat/L, 0.7-35.0), and lower fibrinogen (2.65 g/L; 0.9-3.9) levels then patients who engrafted.

Conclusions

In our cohort, GR was not associated with inferior survival and prompt retransplantation seems to be an effective rescue strategy. GR is characterized by increased levels of inflammation markers, while clinical symptoms are nonspecific. Further analysis in a larger cohort is necessary to assess whether regular monitoring of inflammatory parameters could guide preemptive treatment strategies for GR.

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体外t细胞耗尽的单倍体造血细胞移植后的移植排斥反应：发生率、存活率、危险因素和与炎症生物标志物的关联分析。

背景：移植排斥反应（GR）是单倍体造血细胞移植（haploo - hct）后常见的并发症。目前对GR的临床表现和潜在危险因素的研究较少，没有建立最佳的抢救策略。目的：评估单倍体hct后GR的累积发病率和潜在危险因素，并比较有和没有GR的患者的生存率、临床症状、选定的炎症参数和乳酸脱氢酶水平。方法：回顾性单中心研究，包括79例患者（59名儿童和20名成人），他们于2001年至2020年在sk大学医院接受了体外t细胞去除单倍体hct。结果：GR的累计发生率为14.8% （95% CI: 7.1 ~ 22.6）。中位GR时间为21天（13 ~ 31天）。无GR患者的5年总生存率为45.3% (95% CI: 32.8-57.7)，有GR患者的5年总生存率为41.7% (95% CI: 13.8-69.9) （P = ns）。所有分析的患者和移植相关因素均与GR无显著相关性。黄斑皮疹是唯一与GR相关的症状。GR患者铁蛋白中位数较高(18096µg/L；1412-95,980)和乳酸脱氢酶（10.5µkat/L, 0.7-35.0），较低的纤维蛋白原(2.65 g/L；0.9-3.9)，高于移植患者。结论：在我们的队列中，GR与较差的生存率无关，及时再移植似乎是一种有效的抢救策略。GR的特点是炎症标志物水平升高，而临床症状是非特异性的。有必要在更大的队列中进行进一步分析，以评估定期监测炎症参数是否可以指导GR的先发制人治疗策略。

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

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.