{"title":"中性粒细胞减少时的 C 反应蛋白水平和体温升高可预测成人非亲缘单股脐带血移植的移植和非复发死亡率。","authors":"Takaaki Konuma,Maki Monna-Oiwa,Seiko Kato,Shohei Andoh,Masamichi Isobe,Yasuhito Nannya,Satoshi Takahashi","doi":"10.1016/j.jtct.2024.09.008","DOIUrl":null,"url":null,"abstract":"BACKGROUND\r\nCord blood transplantation (CBT) presents unique challenges related to inflammation during neutropenia, such as mucosal damage, infections, and the potential development of pre-engraftment syndrome or pre-engraftment immune reaction. These factors can contribute to significant inflammation and infection shortly after CBT. However, the effect of severe inflammation during neutropenia, specifically elevated C-reactive protein (CRP) level and body temperature, on post-transplant outcomes after CBT remains unclear.\r\n\r\nOBJECTIVE\r\nThis retrospective study aimed to investigate the association between maximum CRP level, maximum body temperature during neutropenia, and post-transplantation outcomes in adult patients undergoing single-unit CBT.\r\n\r\nSTUDY DESIGN\r\nWe retrospectively evaluated the impact of maximum CRP level and maximum body temperature during neutropenia on post-transplantation outcomes in adults who underwent single-unit unrelated CBT between 1998 and 2023 at our institution.\r\n\r\nRESULTS\r\nA total of 336 adult patients were included in this study. The median maximum CRP level before neutrophil recovery was 7.75 mg/dL (interquartile range [IQR], 4.70 to 12.05 mg/dL) at a median of 14 days (IQR, 8 to 16 days). The median maximum body temperature before neutrophil recovery was 39.5°C (IQR, 39.0 to 40.0°C) at a median of 15 days (IQR, 12 to 17 days). In the multivariate analysis, a maximum CRP level≥20 mg/dL was significantly associated with lower neutrophil recovery (hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.23 to 0.59; P<0.001), lower platelet recovery (HR, 0.28; 95% CI, 0.16 to 0.48; P<0.001), and a higher incidence of veno-occlusive disease/sinusoidal obstruction syndrome (HR, 16.42; 95% CI, 4.11 to 65.54; P<0.001), which resulted in higher non-relapse mortality (NRM) (HR, 5.16; 95% CI, 2.62 to 10.15; P<0.001) and worse overall survival (HR, 2.81; 95% CI, 1.66 to 4.78; P<0.001). Similarly, a maximum body temperature≥40.5°C was significantly associated with lower neutrophil recovery (HR, 0.51; 95% CI, 0.33 to 0.79; P=0.002), lower platelet recovery (HR, 0.55; 95% CI, 0.38 to 0.79; P=0.001), higher incidence of grades III to IV acute GVHD (HR, 2.93; 95% CI, 1.24 to 6.88; P=0.013), and extensive chronic GVHD (HR, 2.47; 95% CI, 1.22 to 4.97; P=0.011), which resulted in higher NRM (HR, 3.43; 95% CI, 1.53 to 7.67; P=0.002).\r\n\r\nCONCLUSION\r\nMaximum CRP level and maximum body temperature during neutropenia were significantly associated with lower hematopoietic recovery and higher NRM following single-unit CBT in adults. Further studies are warranted to explore early intervention strategies aimed at preventing severe inflammation and improving post-transplant outcomes in single-unit CBT.","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":null,"pages":null},"PeriodicalIF":3.6000,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Levels of C-reactive protein and body temperature elevation during neutropenia predict engraftment and non-relapse mortality for unrelated single-unit cord blood transplantation in adults.\",\"authors\":\"Takaaki Konuma,Maki Monna-Oiwa,Seiko Kato,Shohei Andoh,Masamichi Isobe,Yasuhito Nannya,Satoshi Takahashi\",\"doi\":\"10.1016/j.jtct.2024.09.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"BACKGROUND\\r\\nCord blood transplantation (CBT) presents unique challenges related to inflammation during neutropenia, such as mucosal damage, infections, and the potential development of pre-engraftment syndrome or pre-engraftment immune reaction. These factors can contribute to significant inflammation and infection shortly after CBT. However, the effect of severe inflammation during neutropenia, specifically elevated C-reactive protein (CRP) level and body temperature, on post-transplant outcomes after CBT remains unclear.\\r\\n\\r\\nOBJECTIVE\\r\\nThis retrospective study aimed to investigate the association between maximum CRP level, maximum body temperature during neutropenia, and post-transplantation outcomes in adult patients undergoing single-unit CBT.\\r\\n\\r\\nSTUDY DESIGN\\r\\nWe retrospectively evaluated the impact of maximum CRP level and maximum body temperature during neutropenia on post-transplantation outcomes in adults who underwent single-unit unrelated CBT between 1998 and 2023 at our institution.\\r\\n\\r\\nRESULTS\\r\\nA total of 336 adult patients were included in this study. The median maximum CRP level before neutrophil recovery was 7.75 mg/dL (interquartile range [IQR], 4.70 to 12.05 mg/dL) at a median of 14 days (IQR, 8 to 16 days). The median maximum body temperature before neutrophil recovery was 39.5°C (IQR, 39.0 to 40.0°C) at a median of 15 days (IQR, 12 to 17 days). In the multivariate analysis, a maximum CRP level≥20 mg/dL was significantly associated with lower neutrophil recovery (hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.23 to 0.59; P<0.001), lower platelet recovery (HR, 0.28; 95% CI, 0.16 to 0.48; P<0.001), and a higher incidence of veno-occlusive disease/sinusoidal obstruction syndrome (HR, 16.42; 95% CI, 4.11 to 65.54; P<0.001), which resulted in higher non-relapse mortality (NRM) (HR, 5.16; 95% CI, 2.62 to 10.15; P<0.001) and worse overall survival (HR, 2.81; 95% CI, 1.66 to 4.78; P<0.001). Similarly, a maximum body temperature≥40.5°C was significantly associated with lower neutrophil recovery (HR, 0.51; 95% CI, 0.33 to 0.79; P=0.002), lower platelet recovery (HR, 0.55; 95% CI, 0.38 to 0.79; P=0.001), higher incidence of grades III to IV acute GVHD (HR, 2.93; 95% CI, 1.24 to 6.88; P=0.013), and extensive chronic GVHD (HR, 2.47; 95% CI, 1.22 to 4.97; P=0.011), which resulted in higher NRM (HR, 3.43; 95% CI, 1.53 to 7.67; P=0.002).\\r\\n\\r\\nCONCLUSION\\r\\nMaximum CRP level and maximum body temperature during neutropenia were significantly associated with lower hematopoietic recovery and higher NRM following single-unit CBT in adults. Further studies are warranted to explore early intervention strategies aimed at preventing severe inflammation and improving post-transplant outcomes in single-unit CBT.\",\"PeriodicalId\":23283,\"journal\":{\"name\":\"Transplantation and Cellular Therapy\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2024-09-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Transplantation and Cellular Therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jtct.2024.09.008\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplantation and Cellular Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jtct.2024.09.008","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEMATOLOGY","Score":null,"Total":0}
Levels of C-reactive protein and body temperature elevation during neutropenia predict engraftment and non-relapse mortality for unrelated single-unit cord blood transplantation in adults.
BACKGROUND
Cord blood transplantation (CBT) presents unique challenges related to inflammation during neutropenia, such as mucosal damage, infections, and the potential development of pre-engraftment syndrome or pre-engraftment immune reaction. These factors can contribute to significant inflammation and infection shortly after CBT. However, the effect of severe inflammation during neutropenia, specifically elevated C-reactive protein (CRP) level and body temperature, on post-transplant outcomes after CBT remains unclear.
OBJECTIVE
This retrospective study aimed to investigate the association between maximum CRP level, maximum body temperature during neutropenia, and post-transplantation outcomes in adult patients undergoing single-unit CBT.
STUDY DESIGN
We retrospectively evaluated the impact of maximum CRP level and maximum body temperature during neutropenia on post-transplantation outcomes in adults who underwent single-unit unrelated CBT between 1998 and 2023 at our institution.
RESULTS
A total of 336 adult patients were included in this study. The median maximum CRP level before neutrophil recovery was 7.75 mg/dL (interquartile range [IQR], 4.70 to 12.05 mg/dL) at a median of 14 days (IQR, 8 to 16 days). The median maximum body temperature before neutrophil recovery was 39.5°C (IQR, 39.0 to 40.0°C) at a median of 15 days (IQR, 12 to 17 days). In the multivariate analysis, a maximum CRP level≥20 mg/dL was significantly associated with lower neutrophil recovery (hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.23 to 0.59; P<0.001), lower platelet recovery (HR, 0.28; 95% CI, 0.16 to 0.48; P<0.001), and a higher incidence of veno-occlusive disease/sinusoidal obstruction syndrome (HR, 16.42; 95% CI, 4.11 to 65.54; P<0.001), which resulted in higher non-relapse mortality (NRM) (HR, 5.16; 95% CI, 2.62 to 10.15; P<0.001) and worse overall survival (HR, 2.81; 95% CI, 1.66 to 4.78; P<0.001). Similarly, a maximum body temperature≥40.5°C was significantly associated with lower neutrophil recovery (HR, 0.51; 95% CI, 0.33 to 0.79; P=0.002), lower platelet recovery (HR, 0.55; 95% CI, 0.38 to 0.79; P=0.001), higher incidence of grades III to IV acute GVHD (HR, 2.93; 95% CI, 1.24 to 6.88; P=0.013), and extensive chronic GVHD (HR, 2.47; 95% CI, 1.22 to 4.97; P=0.011), which resulted in higher NRM (HR, 3.43; 95% CI, 1.53 to 7.67; P=0.002).
CONCLUSION
Maximum CRP level and maximum body temperature during neutropenia were significantly associated with lower hematopoietic recovery and higher NRM following single-unit CBT in adults. Further studies are warranted to explore early intervention strategies aimed at preventing severe inflammation and improving post-transplant outcomes in single-unit CBT.