Analysis Of Risk Factors Associated With Platelet Transfusion Refractoriness And A Retrospective Study Of Its Effect On The Prognosis Of Hematopoietic Stem Cell Transplantation

A meta-analysis of risk factors associated with platelet transfusion refractorinessBackground:Platelet transfusion refractoriness(PTR)remains an intractable issue in clinical practice and is common in hematological patients.Currently,immune and non-immune factors are believed to play a role.We conducted a meta-analysis of various risk factors which may contribute to PTR.Methods:Pubmed,Embase,Cochrane library,and Web of Science were selected as research database platforms.Citations included were further assessed for quality and bias using the Newcastle-Ottawa Scale.All analyses were performed using Review Manager version 5.4 and STATA 16.0.Results:The preliminary search revealed 1069 publications,of which seventeen(5929 patients in total)were ultimately included in the quantitative analysis.There was no significant publication bias in the included literature.The following variables were associated with the occurrence of PTR:fever(OR=2.26,95%CI=2.00-2.55,p<0.00001),bleeding(OR=2.10,95%CI=1.36-3.24,p=0.0008),female sex(OR=2.06,95%CI=1.13-3.75,p=0.02),antibiotic use(OR=2.94,95%CI=1.54-5.59,p=0.001),and infection(OR=2.19,95%CI=1.20-4.03,p=0.01).Antibodies involved in immune activation were a higher risk factor(OR=4.17,95%CI=2.36-7.36,p<0.00001),and splenomegaly was almost significant(OR=1.73,95%CI=0.97-3.07,p=0.06).After the heterogeneity was reduced using one-by-one exclusion method,the analysis using a fixed-effects model showed that the pooled OR value of antibodies as a risk factor was 5.07,95%CI was 3.84 to 6.69.Conclusion:We identified some important risk factors for PTR,but further research is needed to identify the many other possible elements that may contribute to or mediate PTR.A retrospective study of the effect of platelet transfusion refractoriness on the prognosis of hematopoietic stem cell transplantationBackground:Platelet transfusion refractoriness occurs when a patient receives sufficient ABO matched platelet transfusions from a random donor and the platelet count fails to increase effectively for two or more consecutive transfusions.Many risk factors are not fully clear,and it significantly prolongs the length of hospital stay and increases hospitalization costs once PTR occurs.With the widespread development of allogeneic hematopoietic stem cell transplantation(allo-HSCT),we aimed to explore risk factors of PTR in patients with hematological diseases,and to evaluate the impact of a history of PTR on the prognosis of patients with hematological diseases after transplantation.Methods:The clinical data of 108 newly diagnosed patients with hematological diseases who underwent allogeneic hematopoietic stem cell transplantation in our hospital from January 2019 to December 2020 were retrospectively analyzed.The diagnosis of platelet transfusion refractoriness was judged by corrected count increment(CCI).Patients were divided into PTR group(n=56)and non-PTR group(n=52).Kaplan-Meier curve and Cox proportional hazard model were used to analyze the effect of PTR on the prognosis of transplantation.Results:The positive levels of anti-HLA-Ⅰ and anti-HLA-Ⅱ antibodies in the PTR group were significantly different from those in the non-PTR group.After multivariable logistic regression,we found that splenomegaly(OR=26.98,p<0.001)and JAK mutation(OR=17.32,p=0.024)were independent risk factors for PTR.During the period of transplantation,patients in the PTR group had a significantly higher platelet transfusion demand,which was reflected in the increased number of platelet transfusions(10.23±6.696 vs.5.06±1.904,p<0.001).On the day of reinfusion of stem cells,the PLT count(×109/L)of patients in the PTR group was lower than that of patients in non-PTR group(18.5 vs 24.0,p=0.016).Taking other transplant conditions such as donor,hematological diseases,etc.into consideration,PTR turned out to obviously affect the PLT level on the reinfusion day.The trend in post-transplant platelet levels was higher in the non-PTR group than in the PTR group.Multivariate regression analysis showed that platelet transfusion refractoriness was an independent risk factor for poor overall survival after transplantation(HR=2.794,95%CI=1.083-7.207,p=0.034).Conclusion:We found that splenomegaly and JAK gene mutation were independent risk factors for PTR in patients with hematological diseases.Therefore,spleen reduction and JAK inhibitors in the treatment of PTR may be worth exploring.The history of platelet transfusion refractoriness before allo-HSCT indicates poor prognosis in patients with hematological diseases.