title: Incidence and risk factors for life-threatening bleeding after allogeneic stem cell transplant.
abstract: Bleeding is a frequent complication after allogeneic haematopoietic stem cell transplantation (HSCT) and may affect survival. The purpose of this study was to determine the incidence and risk factors for life-threatening bleeding after HSCT by retrospective evaluation of 491 allogeneic HSCT recipients. With a median follow-up of 33 months, 126 out of 491 allogeneic HSCT recipients experienced a haemorrhagic event (25·7%) and 46 patients developed a life-threatening bleeding episode (9·4%). Pulmonary and gastrointestinal bleeding were the most common sites for life-threatening bleeding, followed by central nervous system. In multivariate analyses, the presence of severe thrombocytopenia after day +28 and the development of grade III-IV acute graft-versus-host disease (GVHD) or thrombotic microangiopathy (TMA) retained their association with life-threatening bleeding events. The overall survival at 3 years among patients without bleeding was 67·1% for only 17·1% for patients with life-threatening bleeding (P < 0·001). In conclusion, life-threatening bleeding is a common complication after allogeneic HSCT. Prolonged severe thrombocytopenia, acute grade III-IV GVHD and TMA were associated with its development.
authors: Servicio de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.|Servicio de Hematología, Hospital Universitario de Burgos, Burgos, Spain.|Centro de Investigación del Cáncer, IBMC Departamento de Medicina, USAL, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
authors: Jorge
authors: J
authors: Labrador
authors: Servicio de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
authors: Lucia
authors: L
authors: López-Corral
authors: Servicio de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
authors: Lourdes
authors: L
authors: Vazquez
authors: Servicio de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
authors: Fermin
authors: F
authors: Sánchez-Guijo
authors: Centro de Investigación del Cáncer, IBMC Departamento de Medicina, USAL, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
authors: Carmen
authors: C
authors: Guerrero
authors: Departamento de Estadística, Universidad de Salamanca, Salamanca, Spain.
authors: Mercedes
authors: M
authors: Sánchez-Barba
authors: Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
authors: Francisco S
authors: FS
authors: Lozano
authors: Servicio de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
authors: Ignacio
authors: I
authors: Alberca
authors: Servicio de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.|Centro de Investigación del Cáncer, IBMC Departamento de Medicina, USAL, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
authors: María C
authors: MC
authors: Del Cañizo
authors: Servicio de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
authors: Dolores
authors: D
authors: Caballero
authors: Servicio de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
authors: Jose R
authors: JR
authors: González-Porras
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects; D014184:Transplantation, Homologous
keywords: graft-versus-host disease; haematopoietic stem cell transplantation; haemorrhage; risk factors; thrombocytopenia