摘要
Background:The impacts of previous cardio-cerebrovascular disease(pre-CCVD)on the outcomes of hematopoietic cell transplantation(HCT)are not well described.Patients with pre-CCVD may often be poor candidates for HCT.This study aimed to investigate the impact of pre-CCVD on transplant outcomes.Methods:A retrospective study was conducted between patients with and without pre-CCVD who consecutively received allogeneic or autologous HCT between November 2013 and January 2020 with a matching of age and disease status.The cardiovascular complications and HCT outcomes of the two groups were evaluated and compared.The primary endpoints were post-transplant cardio-cerebrovascular disease(post-CCVD)and non-relapse mortality(NRM).We used a multivariable Cox proportional hazard model and the Fine-Gray competing risk regressions for analyses to estimate the hazard ratios(HRs).Results:The outcomes of 23 HCT recipients with pre-CCVD were compared with those of 107 patients in the control group.No significant differences were noted in terms of engraftment,overall survival(OS)(67.00%vs.67.90%,P=0.983),or relapse(29.78%vs.28.26%,P=0.561)between the pre-CCVD group and the control group.The cumulative incidences of 2-year NRM were similar between patients with pre-CCVD and the controls(14.68%vs.17.08%,P=0.670).However,pre-CCVD was associated with an increased incidence of post-CCVD(HR:12.50,95%confidence interval[CI]:3.88–40.30,P<0.001),which was an independent risk factor for increased NRM(HR:10.29,95%CI:3.84–27.62,P<0.001)and inferior OS(HR:10.29,95%CI:3.84–27.62,P<0.001).Conclusions:These findings suggest that the existence of pre-CCVD before transplantation might not result in increased mortality directly but superpose the toxicity of the transplantation procedure,leading to a risk of post-CCVD.Post-CCVD was a powerful predictor for high NRM and inferior OS.Further risk stratification of pre-CCVD is needed to reduce NRM in various transplantation settings.
基金
partially supported by grants from the Beijing Nova Program(No.2011114)
the National Natural Science Foundation of China(Nos.82070178 and 81700122)
the Beijing Natural Science Foundation of China(Nos.7172200 and 7132217)
the Capital's Funds for Health Improvement and Research(No.2016-1-4082)
the Fund Sponsorship of the Capital Public Health Project(No.Z171100000417037)
Hainan Provincial Natural Science Foundation of China(No.818MS157)
Military Translational Medicine Fund of Chinese PLA General Hospital(No.ZH19003)
Medical big data and artificial intelligence development fund of Chinese PLA General Hospital(No.2019MBD-016).
