Clinical Reserch About Complications Of Thalassemia Major In Children After Allogeneic Hematopoietic Stem Cell Transplantation

ObjectiveTo do a retrospective clinical analysis of thalassemia major patients after HSCT suffered from AKI,Gv HD,HC,HVOD,summarizing the morbidity,analyzing what kinds of related factors especially thalassemia pathology status,different kinds of nationalities and the different types of HSCT may have effect on complications for improving the successful rate and decreasing the incidence rate of complications in thalassemia major patients after HSCT..MethodsAnalyze retrospectively of 152 thalassemia major patients who were under the age of 15 with hematopoietic stem cell transplantation in our hospital between January 2003 and December 2014,a total of 12 years.According to the including criterion,we observed the occurrence of complications and potential risk factors of patients after HSCT.We monitored complications and infection according to diagnostic criterion and collected data after using unified conditioning regimen,Gv HD prophylaxis and regimen of HSCT for patients.SPSS 20.0 software was applied for statistical treatment.Rank sum text for continuous variable,Chi-square text for categorical variable,binary Logistic regression analysis was available when results of univariate analysis were significant;Risk classification of thalassemia before HSCT,types of HSCT and grade of iron overload and etc.after HSCT were compared in pairs via Bonferroni adjustment when the results of univariate analysis were significant,and we estimated Cys C via ROC curve.ResultTotal of 152 patients,male 108,female 44,the age median of 4 years(1-15years)were involved.1.The clinical analysis of AKI after HSCT(1)The total incidence of AKI after HSCT was 23.68%,the median of occurrence was 11 d;(2)Gender,infection,Han nationality and different types of HSCT were risk factors for AKI occurred(P<0.05),the multivariate Logistic analysis showed that different types of HSCT(OR=1.650,P=0.007,95%CI:1.146?2.378)and infection(OR=2.484,P=0.029,95%CI:1.099?5.612)were independent risk factors of AKI,the difference was statistically significant;(3)Scr increased after HSCT compared with the baseline of Scr,the difference was significant(P<0.05),Cys C increased instantly after CY,compared with base line of Cys C,the difference was significant on+30d(P<0.05).(4)The ROC curve showed that the sensitivity of Cys C(at 1.108mg/L)in the diagnosis of AKI was 47.83%,specificity is 96%.2.Clinical analysis results of occurrence of Gv HD after HSCT(1)The incidence of a Gv HD after HSCT was 26.97%,including grade?of21.95%,grade?of 51.22%,grade?of 26.83%,the median of occurrence was25 days after HSCT,duration of 11.5 days;(2)a Gv HD group input of CD34+cells(13.2 x 10~6/kg)was significantly higher than non-Gv HD input of CD34+cells(6.11 x 10~6/kg)(P=0.002);(3)The occurrence of a Gv HD after HSCT had relationship with infection,there was significant difference that 36.49%patients of a Gv HD got infection(OR=2.626,P=0.010);(4)Children with thalassemia of different risk classification had difference about the occurrence of a Gv HD,the incidence of Gv HD after HSCT in children with grade?(60%)shared the highest rate,grade?and?of the incidence of a Gv HD did not differ between patients.And grade?and?of the thalassemia children with a Gv HD was given priority to with level 1 and level 2;(5)Compared with different types of HSCT,The incidence of a Gv HD caused by PBSCT was 60%,higher than that of sibling CBT+BMT(11.1%)(P<0.01);3.Clinical analysis results of HC after transplantation(1)The incidence of HC after HSCT was 27.63%,the median time of HC was21 d,duration time was 11d,except 1 case of early-onset HC(EOHC),another41 cases were late onset HC(LOHC);(2)The incidence rate of HC in group aged over 4 years was higher than group less than 4 years,the difference was significant(P=0.021);(3)Iron overload may have influence on the incidence rate of HC.With the elevating level of SF,especially over 7969.84?g/L,the incidence rate of HC increased obviously;(4)There were not relative for HC with children age,nationalities,donor gender whether matched,transfusion of the amount of CD34~+cells,plasma concentration of cyclosporine A,SF level before and after HSCT,and whether the occurrence of cytomegalovirus infection,AKI,Gv HD and HVOD after HSCT.There were not associated with risk classification of thalassemia,different types of HSCT and iron overload yet(P>0.05).4.Clinical analysis results of HVOD after HSCT(1)The incidence of HVOD after HSCT was 27.63%,the median was 11 days,15 days of duration,all of them were moderate HVOD,no patient died;(2)There were not relative for HVOD with children age,nationalities,donor gender whether matched,transfusion of the amount of CD34~+cells,plasma concentration of cyclosporine A,SF level before and after HSCT,and whether the occurrence of cytomegalovirus infection,AKI,Gv HD and HC after HSCT.There were not associated with risk classification of thalassemia, different types of HSCT and iron overload yet(P>0.05).5.Clinical analysis of dead cases(1)The main causes of 11 dead cases:5 infection(45.45%),2 pulmonary hemorrhage(18.18%);(2)The main complications after HSCT in dead cases:10 infection(90.90%),5AKI(45.45%);(3)There were 8 dead cases after S-CBT+BMT(72.72%).Conclusion1.The incidence of AKI for thalassemia after HSCT was 23.68%,infection and unrelated PBSCT were the risk factors for AKI after HSCT;the sensitivity of Cys C in early diagnosis of AKI was not superior to Scr;2.The main grade of a Gv HD in thalassemia children after HSCT were grade?and grade?;input of high dose CD34~+cells and infection were independent risk factors for a Gv HD after HSCT;the incidence rate of a Gv HD of unrelated PBSCT was higher than that of sibling CBT+BMT;incidence of a Gv HD in children of degree?after HSCT was higher than that of grade I;3.Iron overload may have influence on the incidence rate of HC.With the elevating level of SF,especially over 7969.84?g/L,the incidence rate of HC increased obviously.The group aged over 4 years was more superior to suffering from HC than group less than 4 years.4.There were not relative for HVOD with transplantation related factors,status of thalassemia and different types of transplantations.5.The main complication and dead cause after HSCT was infection in this research.