Retrospective Investigation of Hemostatic Complications In 423 Patients Receiving Hematopoietic Stem-Cell Transplantation (HSCT).

Thrombotic and bleeding events are common and potentially fatal complications in patients receiving hematopoietic stem-cell transplantation (HSCT), which is profoundly associated with the survival of HSCT recipients. The hemostatic imbalance and endothelial injury are main manifestations in the course of HSCT, leading to thrombotic or bleeding disorders; however, there is still a lack of information on early differential diagnosis and prevention of those complications. In this study, we retrospectively investigated the outcomes and the risk factors of thrombotic and bleeding complications in HSCT recipients, and determined the clinical significance of hemostatic factors in thrombotic and bleeding events after HSCT.

423 hematologic patients receiving HSCT (113 auto-HSCT and 310 allo-HSCT recipients) were enrolled in the study, and their clinical manifestation and laboratory parameters were analyzed for evaluating the outcomes of hemostatic complications and related risk factors.

The overall incidence of bleeding disorders in 423 HSCT recipients was 65% (275 cases), in which 211 cases (76.8%) are allo-HSCT recipients. Bleeding was identified and evaluated based on a daily score of intensity. Minor bleeding was seen in 74.9% (206 cases), moderate bleeding was seen in 21.8% (60 cases), and severe bleeding was seen in 3.3% (9 cases) of all bleeding patients. The organs of hemorrhage involve skin or mucosa (36% in all HSCT recipients), gastrointestinal tract (36%), lung (1.2%), brain (0.4%), and urinary (39%). In regards to thrombotic complications, 12 recipients (2.8% in all HSCT recipients) developed thrombotic events, including 9 veno-occlusive diseases (VOD), 1 transplantation related thrombotic microangiopathy (TA-TMA), 1 pulmonary embolism (PE) and 1 deep vein thrombosis (DVT). The overall mortality after thrombotic events was 66.7% (8 cases) in all HSCT recipients with thrombotic complications. Both thrombotic and bleeding disorders were significantly correlated with age, disease category and pretreatment regimen (P<0.05), but not associated with gender, transplantation types, routine hemostatic parameters, and biochemical indicators (P>0.05). No difference was found in the reconstruction time required for haematogenesis between recipients with or without bleeding disorders (P>0.05), but the survival rate was correlated with the site and intensity of bleeding disorders (P<0.05). In addition, polyoma viruria and II-IV grade aGVHD were the independent risk factors for hemorrhagic cystitis. PAI-1 level in the HSCT recipients with thrombotic complications are significantly higher than those with other complications and toxicities (graft-versus-host disease, infections, and preparative regimen toxicity) (P<0.01).

Our study showed that the HSCT patients with bleeding disorders presented high morbidity while the HSCT recipients with the thrombotic complications had high mortality. Some of the risk factors and hemostatic parameteters were correlated with thrombotic or bleeding complications. Therefore, our observations suggest the necessity to diagnose and treat hemostatic complications early to improve the prognosis of HSCT recipients.

No relevant conflicts of interest to declare.