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Overt gastrointestinal bleeding following haploidentical haematopoietic stem cell transplantation: incidence, outcomes and predictive models

Bone Marrow Transplantation volume 56, pages 1341–1351 (2021)Cite this article

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Abstract

Gastrointestinal bleeding (GIB) accounts for a significant proportion of life-threatening bleeding cases occurring after allogeneic haematopoietic stem cell transplantation (allo-HSCT). However, data on GIB after haploidentical HSCT (haplo-HSCT) are not available. A total of 3180 patients received haplo-HSCT at Peking University People’s Hospital from January 2015 to November 2019, and GIB occurred in 188 of these patients (incidence of 5.9%). Platelet counts <30 × 109/L, viral hepatitis, acute kidney injury (AKI), gastrointestinal disease or bleeding before HSCT and sinusoidal obstruction syndrome (SOS) were determined to be significant risk factors for the occurrence of GIB after haplo-HSCT. Grade III-IV acute graft-versus-host disease (aGVHD), AKI, thrombotic microangiopathy (TMA), disseminated intravascular coagulation (DIC) and gastrointestinal disease or bleeding before HSCT were significantly related to mortality in patients with GIB after haplo-HSCT. The predictive models developed for the occurrence and mortality of GIB performed well in terms of discrimination, and they might assist clinicians with personalised strategies for GIB prevention and treatment in patients after haplo-HSCT.

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Fig. 1: Flow chart of patient screening.
Fig. 2: Clinical outcomes of patients with GIB after haplo-HSCT.
Fig. 3: Estimation of GIB occurrence stratified by the predictive model.
Fig. 4: Survival of patients stratified by the predictive model for GIB.
Fig. 5: Performance of the predictive model on discriminating GIB following haplo-HSCT.
Fig. 6: Estimation of mortality of patients with GIB stratified by the predictive model.
Fig. 7: Performance of the predictive model on discriminating mortality of patients with GIB following haplo-HSCT.

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Acknowledgements

This work was supported by the National Key Research and Development Programme of China (No. 2017YFA0105503, No. 2017YFA0105500), Key Programme of National Natural Science Foundation of China (No. 81730004), National Natural Science Foundation of China (No. 81670116), Foundation for Innovative Research Groups of the National Natural Science Foundation of China (81621001), Beijing Natural Science Foundation (No. 7171013, H2018206423) and Beijing Municipal Science and Technology Commission (No. Z171100001017084).

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  1. These authors contributed equally: Xueyan Sun, Yan Su, Xiao Liu

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  1. Peking University People’s Hospital, Peking University Institute of Haematology, Beijing, China

    Xueyan Sun, Yan Su, Xiao Liu, Yuanyuan Zhang, Yun He, Wei Han, Qi Chen, Huan Chen, Yu Wang, Yifei Cheng, Fengqi Liu, Fengrong Wang, Yao Chen, Gaochao Zhang, Xiaodong Mo, Haixia Fu, Yuhong Chen, Jingzhi Wang, Xiaolu Zhu, Lanping Xu, Kaiyan Liu, Xiaojun Huang & Xiaohui Zhang

  2. Beijing Key Laboratory of Haematopoietic Stem Cell Transplantation, Beijing, China

    Xueyan Sun, Yan Su, Xiao Liu, Yuanyuan Zhang, Yun He, Wei Han, Qi Chen, Huan Chen, Yu Wang, Yifei Cheng, Fengqi Liu, Fengrong Wang, Yao Chen, Gaochao Zhang, Xiaodong Mo, Haixia Fu, Yuhong Chen, Jingzhi Wang, Xiaolu Zhu, Lanping Xu, Kaiyan Liu, Xiaojun Huang & Xiaohui Zhang

  3. Collaborative Innovation Center of Haematology, Peking University, Beijing, China

    Xueyan Sun, Yan Su, Xiao Liu, Yuanyuan Zhang, Yun He, Wei Han, Qi Chen, Huan Chen, Yu Wang, Yifei Cheng, Fengqi Liu, Fengrong Wang, Yao Chen, Gaochao Zhang, Xiaodong Mo, Haixia Fu, Yuhong Chen, Jingzhi Wang, Xiaolu Zhu, Lanping Xu, Kaiyan Liu, Xiaojun Huang & Xiaohui Zhang

  4. National Clinical Research Center for Haematologic Disease, Beijing, China

    Xueyan Sun, Yan Su, Xiao Liu, Yuanyuan Zhang, Yun He, Wei Han, Qi Chen, Huan Chen, Yu Wang, Yifei Cheng, Fengqi Liu, Fengrong Wang, Yao Chen, Gaochao Zhang, Xiaodong Mo, Haixia Fu, Yuhong Chen, Jingzhi Wang, Xiaolu Zhu, Lanping Xu, Kaiyan Liu, Xiaojun Huang & Xiaohui Zhang

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Sun, X., Su, Y., Liu, X. et al. Overt gastrointestinal bleeding following haploidentical haematopoietic stem cell transplantation: incidence, outcomes and predictive models. Bone Marrow Transplant 56, 1341–1351 (2021). https://doi.org/10.1038/s41409-020-01187-5

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