title: Clinical significance of hemophagocytosis in BM clot sections during the peri-engraftment period following allogeneic hematopoietic SCT.
abstract: The effects of macrophage activation on the outcome of allogeneic hematopoietic SCT (allo-HSCT) have yet to be fully examined. A total of 70 adult patients who received a first allo-HSCT for hematological diseases were studied. We counted the number of hemophagocytic cells in BM clot sections on day +14±7, and analyzed its impact on subsequent outcome. In all, 23 patients were diagnosed as having increased numbers of hemophagocytic cells (HP group), whereas 47 were not (non-HP group). The HP group was not associated with an increased incidence of acute or chronic GVHD, but was associated with worse hematopoietic recovery than the non-HP group. The 2-year OS for the HP group and the non-HP group was 30 and 65% (P<0.01), respectively, and 2-year non-relapse mortality was 48% and 27% (P<0.01), respectively. Multivariate analysis confirmed that the HP group was associated with a lower OS (hazard ratio (HR)=2.3; 95% confidence interval (CI), 1.0-5.4; P=0.048) and higher non-relapse mortality (HR=4.0; 95% CI, 1.6-9.9; P<0.01). The HP group had higher incidences of death due to graft failure (P<0.01) and endothelial complications, such as sinusoidal obstruction syndrome and transplant-associated microangiopathy (P=0.01). Macrophage activation is a previously unrecognized complication with negative impact on outcome of allo-HSCT.
authors.affiliation: Department of Hematology, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, Aichi, Japan. nobuimaima@hotmail.com
authors.forename: N
authors.initials: N
authors.lastname: Imahashi
authors.forename: Y
authors.initials: Y
authors.lastname: Inamoto
authors.forename: M
authors.initials: M
authors.lastname: Ito
authors.forename: D
authors.initials: D
authors.lastname: Koyama
authors.forename: T
authors.initials: T
authors.lastname: Goto
authors.forename: K
authors.initials: K
authors.lastname: Onodera
authors.forename: A
authors.initials: A
authors.lastname: Seto
authors.forename: K
authors.initials: K
authors.lastname: Watanabe
authors.forename: M
authors.initials: M
authors.lastname: Imahashi
authors.forename: S
authors.initials: S
authors.lastname: Nishiwaki
authors.forename: S
authors.initials: S
authors.lastname: Tsukamoto
authors.forename: T
authors.initials: T
authors.lastname: Yasuda
authors.forename: Y
authors.initials: Y
authors.lastname: Ozawa
authors.forename: K
authors.initials: K
authors.lastname: Miyamura
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006413:Hematopoietic System; D006801:Humans; D008262:Macrophage Activation; D008875:Middle Aged; D015999:Multivariate Analysis; D010587:Phagocytosis; D012008:Recurrence; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome