血小板输注无效在慢性粒-单核细胞白血病患者异基因造血干细胞移植后的发生率及临床意义

OBJECTIVE: To retrospectively analyze the incidence and clinical significance of platelet transfusion refractoriness (PTR) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with chronic myelomonocytic leukemia (CMML). METHODS: A cohort of 55 CMML patients received allo-HSCT at Peking University Institute of Hematology during 2004–2021 were retrospectively assessed. The incidence of PTR within 30 days after allo-HSCT was retrospectively analyzed, and the impact on clinical outcomes and bleeding event were compared between patients with platelet transfusion refractoriness (PTR) or effective platelet transfusion (EPT). RESULTS: The incidence of PTR after allo-HSCT in CMML patients was 25.5％ (14/55). PTR patients had a lower rate of platelet engraftment than EPT patients (28.6％ vs 100％), and the median time of engraftment was 67 (33–144) days and 21 (9–157) days respectively (P<0.010). There was no significant difference between two groups in acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD) (P＝0.183, P＝0.455). After following-up a median of 684 (24–3978) days, the 1-year overall survival (OS) and 1-year leukemia free survival (LFS) in PTR and EPT patients were (35.4±13.9)％ vs (75.1±7.8)％ (P＝0.037) and (28.1±13.3)％ vs (65.3±8.2)％ (P＝0.072), respectively. The transplant-related mortality (TRM) were (48.2±2.4)％ and (9.0±0.25)％, respectively (P＝0.009). Bleeding events occurred in five patients (35.7％) of PTR and 2 patients (4.9％) of EPT (P＝0.009). CONCLUSION: In CMML patients with allo-HSCT, the incidence of PTR is 25.5％, which was associated with delayed platelet engraftment, increased bleeding events, inferior OS and increased TRM.