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Title: [Clinical characteristics and risk factors of pericardial effusion after hematopoietic stem cell transplantation in children with thalassemia major].
Author: Yang CL, Wang XD, Zhou XH, Wang CJ, Zhang XL, Li Y, Yu Y, Liu SX.
Journal: Zhonghua Er Ke Za Zhi; 2022 Apr 02; 60(4):323-328. PubMed ID: 35385938.
Abstract:
Objective: To investigate the characteristics, risk factors and outcomes of thalassemia major (TM) children with pericardial effusion (PE) after allo-geneic hematopoietic stem cell transplantation (allo-HSCT). Methods: Clinical data of 446 TM children received allo-HSCT at Shenzhen Children's Hospital between January 2012 and December 2020 were analyzed retrospectively. Patients were divided into PE and non-PE group according to the occurrence of PE. Chi-square tests were used to investigate the risk factors that were associated with the development of PE. Kaplan-Meier method was used for survival analysis of the 2 groups. Results: Twenty-five out of 446 patients (5.6%) developed PE at a time of 75.0 (66.5, 112.5) days after allo-HSCT. Among these patients, 22 cases (88.0%) had PE within 6 months after allo-HSCT and 19 patients (76.0%) had PE within 100 days after allo-HSCT. The diagnoses of PE were confirmed using echocardiography. Pericardial tamponade was observed in only 1 patient, who later undergone emergency pericardiocentesis. The rest of patients received conservative managements alone. PE disappeared in all patients after treatment. Risk factors that were associated with the development of PE after allo-HSCT included the gender of patients, the type of transplantation, the number of mononuclear cells (MNC) infuse, pulmonary infection after HSCT and transplantation associated thrombotic microangiopathy (TA-TMA) (χ²=3.99, 10.20, 14.18, 36.24, 15.03, all P<0.05). In 239 patients that received haploidentical HSCT, the development of PE was associated with the gender of patients, pulmonary infection after HSCT and TA-TMA (χ²=4.48, 20.89, 12.70, all P<0.05). The overall survival rates of PE and non-PE groups were 96.0% (24/25) and 98.6% (415/421). The development of PE was not associated with the overall survival of TM children after allo-HSCT (χ²=1.73, P=0.188). Conclusions: PE mainly develop within 100 days after allo-HSCT in pediatric TM recipients. Haploidentical grafts, female gender, pulmonary infection after HSCT and TA-TMA are the main risk factors associated with PE development after transplant. However, the presence of PE don't have a significant impact on the outcomes of pediatric TM patients after allo-HSCT. 目的： 探讨重型地中海贫血（TM）患儿异基因造血干细胞移植（allo-HSCT）术后心包积液发生的特点、危险因素及预后。 方法： 病例对照研究。选择2012年1月至2020年12月在深圳市儿童医院血液肿瘤科造血干细胞移植中心行allo-HSCT的446例TM患儿为研究对象，分析其心包积液发生情况，根据是否发生心包积液分成心包积液组和非心包积液组，分析TM患儿allo-HSCT术后心包积液发生的危险因素，采用Kaplan-Meier法进行两组患儿的生存分析。 结果： 446例患儿中25例发生了心包积液，发生率为5.6%，心包积液发生的时间为移植后75.0（66.5，112.5）d，25例中有22例（88.0%）心包积液发生在移植半年以内，有19例（76.0%）发生在移植100 d以内。所有患儿均通过心脏超声确诊心包积液，其中仅1例发生心包填塞，行急诊心包穿刺抽液治疗，其他均为保守治疗。25例患儿经治疗心包积液均消失。TM患儿allo-HSCT术后心包积液的发生与性别、移植供者类型、输注的单个核细胞（MNC）数量、移植术后肺部感染及移植相关血栓性微血管病（TA-TMA）均有关（χ²=3.99、10.20、14.18、36.24、15.03，均P<0.05）。239例单倍型造血干细胞移植TM患儿心包积液的发生与性别、移植术后肺部感染及TA-TMA均相关（χ²=4.48、20.89、12.70，均P<0.05）。心包积液患儿生存率为96.0%（24/25），非心包积液患儿生存率为98.6%（415/421），心包积液对allo-HSCT 的TM患儿总体生存率影响差异无统计学意义（χ²=1.73，P=0.188）。 结论： TM患儿allo-HSCT术后心包积液发生主要在移植后100 d内，发生的高危因素主要为单倍型移植、女性、移植术后肺部感染及TA-TMA。移植后心包积液对于allo-HSCT的TM患儿预后无显著影响。.

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