Endothelial Activation and Stress Index-Measured Pretransplantation Predicts Transplantation-Related Mortality in Patients with Thalassemia Major Undergoing Transplantation with Thiotepa, Treosulfan, and Fludarabine Conditioning.

Autor: Kulkarni UP; Department of Haematology, Christian Medical College, Vellore, India., Pai AA; Department of Haematology, Christian Medical College, Vellore, India., Kavitha ML; Department of Haematology, Christian Medical College, Vellore, India., Selvarajan S; Department of Haematology, Christian Medical College, Vellore, India., Lionel S; Department of Haematology, Christian Medical College, Vellore, India., Devasia AJ; Department of Haematology, Christian Medical College, Vellore, India., Korula A; Department of Haematology, Christian Medical College, Vellore, India., Fouzia NA; Department of Haematology, Christian Medical College, Vellore, India., Sindhuvi E; Department of Haematology, Christian Medical College, Vellore, India., Abraham A; Department of Haematology, Christian Medical College, Vellore, India., Srivastava A; Department of Haematology, Christian Medical College, Vellore, India., Mathews V; Department of Haematology, Christian Medical College, Vellore, India., George B; Department of Haematology, Christian Medical College, Vellore, India., Balasubramanian P; Department of Haematology, Christian Medical College, Vellore, India. Electronic address: bpoonkuzhali@cmcvellore.ac.in.
Jazyk: angličtina
Zdroj: Transplantation and cellular therapy [Transplant Cell Ther] 2022 Jul; Vol. 28 (7), pp. 356.e1-356.e6. Date of Electronic Publication: 2022 May 09.
DOI: 10.1016/j.jtct.2022.05.001
Abstrakt: The use of thiotepa-treosulfan-fludarabine conditioning regimen and peripheral blood stem cell grafts is associated with improved outcomes of hematopoietic stem cell transplantation (HCT) in patients with high-risk thalassemia major. However, there remains a need to identify predictors of poor outcomes in this cohort to further optimize outcomes. The Endothelial Activation and Stress Index (EASIX) is a biomarker shown to predict survival in various settings, including graft-versus-host disease, veno-occlusive disease, and nonrelapse mortality following allogeneic HCT. In this retrospective analysis, we evaluated the role of EASIX-PreTx (measured before conditioning therapy) as a biomarker in predicting day +100 transplantation-related mortality (TRM+100) in 281 patients with thalassemia major who underwent HCT with a uniform conditioning regimen using thiotepa-treosulfan-fludarabine at our center between January 2012 and December 2019. The median patient age was 9 years (range, 1 to 25 years), and 109 (38.8%) were females. According to the Pesaro classification (with Vellore modification), 3 patients (1.1%) were class I, 34 (12.1%) were class II, 134 (47.7%) were class III low risk, and 110 (39.1%) were class III high risk. Stem cell donors were matched sibling (n = 218; 77.6%), matched related nonsibling (n = 23; 8.2%), or matched unrelated (n = 40; 14.2%). Five patients (1.8%) received a bone marrow graft, and the others received a peripheral blood stem cell graft. Thirty-eight patients (13.5%) had TRM+100. EASIX-PreTx was available for 184 patients (65.5%). The median EASIX-PreTx was significantly higher in patients with TRM+100 compared with those without TRM+100 (1.09 versus .75; P = .008). An EASIX-PreTx cutoff of .85 had 70.4% sensitivity and 62% specificity for predicting TRM+100. The TRM+100 for patients with EASIX-PreTx >.85 was significantly higher than those with EASIX <.85 (24.4% versus 7.5%; P = .003). In a uniform subgroup of class III patients undergoing allogeneic HCT (n = 156), EASIX-PreTx was an independent predictor of TRM+100.
(Copyright © 2022 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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