Analysis of incidence, risk factors and clinical outcome of thromboembolic and bleeding events in 431 allogeneic hematopoietic stem cell transplantation recipients.
Allogeneic hematopoietic stem cell transplantation recipients have an increasing risk of both hemorrhagic and thrombotic complications. However, the competing risks of two of these life-threatening complications in these complex patients have still not been well defined. We retrospectively analyzed data from 431 allogeneic transplantation recipients to identify the incidence, risk factors and mortality due to thrombosis and bleeding. Significant clinical bleeding was more frequent than symptomatic thrombosis. The cumulative incidence of a bleeding episode was 30.2% at 14 years. The cumulative incidence of a venous or arterial thrombosis at 14 years was 11.8% and 4.1%, respectively. The analysis of competing factors for venous thrombosis revealed extensive chronic graft-versus-host disease to be the only independent prognostic risk factor. By contrast, six factors were associated with an increased risk of bleeding; advanced disease, ablative conditioning regimen, umbilical cord blood transplantation, anticoagulation, acute III-IV graft-versus-host disease, and transplant-associated microangiopathy. The development of thrombosis did not significantly affect overall survival (P=0.856). However, significant clinical bleeding was associated with inferior survival (P<0.001). In allogeneic hematopoietic stem cell transplantation, significant clinical bleeding is more common than thrombotic complications and affects survival.
Department of Hematology, IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain.
Jorge
J
Labrador
Lucia
L
Lopez-Anglada
Estefania
E
Perez-Lopez
Francisco S
FS
Lozano
Lucia
L
Lopez-Corral
Fermin M
FM
Sanchez-Guijo
Lourdes
L
Vazquez
Jose Angel
JA
Perez Rivera
Francisco
F
Martin-Herrero
Mercedes
M
Sanchez-Barba
Carmen
C
Guerrero
Maria Consuelo
MC
del Cañizo
Maria Dolores
MD
Caballero
Jesus Fernando
JF
San Miguel
Ignacio
I
Alberca
Jose Ramon
JR
Gonzalez-Porras
D000328:Adult; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D013923:Thromboembolism / Q000453:epidemiology* / Q000209:etiology*; D014184:Transplantation, Homologous; D055815:Young Adult