| Objective:Preliminary analysis of the effects of cord blood transfusion after chemotherapy on infection,bleeding,hematopoietic reconstitution and survival in acute myeloid leukemia/myelodysplastic syndrome(AML/MDS).Methods:Through a retrospective study,the clinical data of patients with AML/MDS hospitalized in the Department of Hematology of Shaanxi Provincial People’s Hospital from November 2018 to April 2022 who received chemotherapy followed by cord blood transfusion were collected,and patients with AML/MDS who did not receive cord blood transfusion during the same period were selected as a control study to analyze the effects of chemotherapy combined with cord blood transfusion on postchemotherapy infection,bleeding,granulocyte ≥0.5×109/L and platelets(platelet,PLT)≥20×109/L duration,number of platelet and red blood cells(RBC)transfusions,and patient’s disease remission status and survival,with survival follow-up until patient’s death or January 31,2023,were analyzed by SPSS 18.0 statistical software,with P< 0.05 was considered a statistically significant difference.Results:1.132 patients with AML/MDS,56.1%(74/132)were male and 43.9%(58/132)were female,with a median age of onset of 64(22-87)years.54.5%(72/132)had AML and45.5%(60/132)had MDS,of which 49.2%(65/132)were in the group with cord blood transfusion and 50.8%(67/132)were in the group without cord blood transfusion.50.8%(67/132);15.9%(21/132)for primary diagnosis,50.8%(67/132)for remission,and33.3%(44/132)for refractory relapse.The median number of cord blood transfusions was 2(1 to 12).2.Baseline data of 132 AML/MDS patients,of whom 60%(39/65)were male and40%(26/65)were female in the cord blood transfusion group,with a median age of 65(23-87)years,9.2%(6/65)in primary treatment,52.3%(34/65)in remission,and 38.5%(25/65)in refractory relapse;52.2%(35 /67),47.8%(32/67)in women,median age of onset was 63(22～85)years,22.4%(15/67)in primary treatment,49.3%(33/67)in remission,and 28.4%(19/67)in refractory relapse;there was no significant difference between the two groups at baseline(P > 0.05),which was comparable.3.Effect of cord blood transfusion on hematopoietic reconstitution after antitumor treatmentThe median duration of neutrophils ≥0.5×109/L in the cord blood transfusion group was 12(4,18)days longer than the median duration of neutrophils ≥0.5×109/L in the non-transfused cord blood group of 7(3,15)days(P=0.014);the median duration of platelets ≥20×109/L in the cord blood transfusion group was 8(6,15)days longer than the median duration of platelets ≥20×109/L in the non-transfused cord blood group of 5(3,10)days(P=0.001);suggesting a statistically significant difference in the restoration of hematopoietic function by cord blood transfusion.20×109/L for a median of 5(3,10)days in the group without cord blood transfusion(P=0.001);suggesting a statistically significant difference in the restoration of hematopoietic function with cord blood transfusion.4.Effect of cord blood transfusion on platelet and red blood cell transfusion after anti-leukemia treatmentThe median number of red blood cell transfusions was less in the cord blood transfusion group 1(1,4)than in the non-transfused cord blood group 3(1,5)(P=0.028),and the median number of platelet transfusions was less in the cord blood transfusion group 2(0.5,4)than in the non-transfused cord blood group 3(1,6)(P=0.042).5.Effect of cord blood transfusion on bleeding after anti-leukemia therapy in AML/MDS patientsBleeding was 5.7%(5/65)in the cord blood transfusion group and 31.4%(21/67)in the non-transfused cord blood group,with a comparison of bleeding(P=0.045),suggesting a statistically significant difference between cord blood transfusion on bleeding.6.Effect of cord blood transfusion on infection after anti-leukemia treatment in AML/MDS patientsThere were 70.7%(46/65)infections in the cord blood transfusion group and 89.6%(60/67)infections in the non-transfused cord blood group;the difference in infection comparison was statistically significant(P=0.029).In the cord blood transfusion group,27.7%(18/65)were mildly infected,40%(26/65)were severely infected,and 32.3%(21/65)were not infected;in the non-transfused cord blood group,46.3%(31/67)were mildly infected,41.8%(28/67)were severely infected,and 11.9%(8/67)were not infected.The difference was statistically significant when comparing the degree of infection(P=0.009).7.Effect of cord blood transfusion on remission rate after anti-leukemia therapy in AML/MDS patientsThere were 65 patients with primary and relapsed refractory AML/MDS,including6 cases in the cord blood transfusion group with 12.90% remission rate after treatment(4/31),15 cases in the non-transfused cord blood group with 26.47% remission after treatment(9/34);25 cases in the cord blood transfusion group with refractory relapse and 58.06% remission after treatment(18/31),and 19 cases in the non-transfused cord blood group with refractory relapse.The overall remission rate was 70.96% in the cord blood transfusion group and 38.23% in the non-transfused group.8.Effect of cord blood transfusion on survival in AML/MDSThere was no significant difference in the survival of 132 patients with AML/MDS by cord blood transfusion(P=0.284),no significant difference in the survival of patients who achieved remission by cord blood transfusion(P=0.796),no significant difference in the survival of patients with refractory relapse by cord blood transfusion(P=0.238),no significant difference in the survival of 65 patients with AML/MDS by cord blood transfusion ≥2 times(P= 0.420),no significant difference in survival for 35 patients with AML by ≥ 2 cord blood transfusions(P=0.670),no significant difference in survival for 30 patients with MDS by ≥ 2 cord blood transfusions(P=0.668),no significant difference in survival for 72 patients with AML by cord blood transfusions(P=0.290),and no significant difference in survival for 60 patients with MDS by cord blood transfusions(P= 0.608).Conclusions:1.Chemotherapy combined with cord blood transfusion can reduce the infusion of red blood cells and platelets,accelerate the reconstruction of bone marrow hematopoiesis,and reduce the incidence of post-chemotherapy infection and bleeding in AML/MDS patients.2.Chemotherapy combined with cord blood transfusion effectively improves the remission rate of AML/MDS patients. |
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