Age analysis of graft-versus-host disease after fully matched hematopoietic stem cell transplantation in children with thalassemia

doi:10.12307/2026.796

Abstract

Abstract: BACKGROUND: Graft-versus-host disease is a major complication faced by patients with thalassemia after hematopoietic stem cell transplantation and is the primary cause of high morbidity and non-relapse mortality.
OBJECTIVE: To investigate the situation of graft-versus-host disease in children with thalassemia after hematopoietic stem cell transplantation, and to explore the correlation between the incidence of different severity levels of acute graft-versus-host disease and the age of the children.
METHODS: A total of 281 children with thalassemia who underwent fully matched hematopoietic stem cell transplantation in the Department of Pediatrics, Nanfang Hospital, Southern Medical University from January 2012 to June 2018 were selected. They were divided into three groups according to age: < 5 years old group (Group 1; n=80), 5-8 years old group (Group 2; n=140), and > 8 years old group (Group 3; n=61). The occurrence of graft-versus-host disease was analyzed in each group.
RESULTS AND CONCLUSION: A total of 44 cases of graft-versus-host disease were observed. The incidence rates of graft-versus-host disease in Group 1, Group 2, and Group 3 were 10%, 14.29%, and 26.23%, respectively, with a P-value of 0.026, indicating a significant correlation between the occurrence of graft-versus-host disease and age. Among the 13 patients with chronic graft-versus-host disease, the incidence rates in Group 1, Group 2, and Group 3 were 2.50%, 3.57%, and 9.83%, respectively, with a P-value of 0.049 when comparing the incidence rates. For the 34 cases of acute graft-versus-host disease, there was no significant difference in the incidence rates of Grade I+II and Grade III+IV acute graft-versus-host disease among the three groups. The overall incidence rates of graft-versus-host disease and chronic graft-versus-host disease were significantly correlated with the age of the pediatric patients, with a notable increase in the occurrence of these conditions in children over 8 years old. This suggests that special attention should be given to the occurrence of graft-versus-host disease in older children undergoing thalassemia transplantation, and preventive and monitoring measures should be implemented in advance.

Key words: thalassemia, hematopoietic stem cell transplantation, graft-versus-host disease, older children, full match, age, complication, incidence rate

CLC Number:

Xu Yiqi, Huang Yuming, Wu Xuedong, Feng Xiaoqin, Liu Xuan, Wen Jianyun, Chen Libai, Ruan Yongsheng. Age analysis of graft-versus-host disease after fully matched hematopoietic stem cell transplantation in children with thalassemia[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(31): 8116-8121.

Figures/Tables 4

2.4 急性移植物抗宿主病发生情况 44例患儿发生移植物抗宿主病(有4例患儿在移植后随访中，先后有发生急性和慢性移植物抗宿主病，急性和慢性移植物抗宿主病患儿数据有重复部分)，总发生率为15.66%(44/281)。在年龄分组中，第1组(< 5岁)有8例患儿发生移植物抗宿主病，发生率为10%(8/80)；第2组(5-8岁)有20例患儿发生移植物抗宿主病，发生率为14.29%(20/140)；第3组(> 8岁)则有16例患儿发生移植物抗宿主病，发生率高达26.23%(16/61)，统计学分析P值为0.026(P < 0.05)，表明移植物抗宿主病的发生与年龄可能存在相关性，随着年龄的增大，移植物抗宿主病的发生率呈现上升趋势。 34例患儿发生急性移植物抗宿主病，总发生率为77.27%(34/44)。其中，Ⅰ级和Ⅱ级急性移植物抗宿主病患儿25例，占总发生例数的73.53%(25/34)；Ⅲ级急性移植物抗宿主病患儿5例，Ⅳ级急性移植物抗宿主病患儿3例，Ⅲ级和Ⅳ级急性移植物抗宿主病患儿8例，占总发生例数的23.53%(8/34)。另外，还有1例特殊的移植物抗宿主病患者，考虑为口腔移植物抗宿主病及肺部移植物抗宿主病，故未能分级。在年龄分组方面，第1组(< 5岁)有6例发生急性移植物抗宿主病；第2组(5-8岁)有17例发生急性移植物抗宿主病；第3组(> 8岁)则有11例发生急性移植物抗宿主病，3组急性移植物抗宿主病发生率比较，P值为0.058(P > 0.05)。 3组Ⅰ级和Ⅱ级急性急性移植物抗宿主病发生率比较，P值为0.091(P > 0.05)。3组Ⅲ级和Ⅳ级急性急性移植物抗宿主病发生率比较，P值为0.783(P > 0.05)。 13例患儿发生慢性移植物抗宿主病，发生时间的中位数为5个月。在年龄分组方面，第1组(< 5岁)有2例发生慢性移植物抗宿主病；第2组(5-8岁)有5例发生慢性移植物抗宿主病；第3组(> 8岁)有7例发生慢性移植物抗宿主病。3组慢性移植物抗宿主病发生率比较，P值为0.049(P < 0.05)。见表2及图2。"

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