Risk Factors and Clinical Outcome of Thrombotic and Bleeding Complications in 527 Patients Following Hematopoietic Stem-Cell Transplantation (HSCT)

Hemostatic disorders are common and potentially fatal complications in patients undergoing hematopoietic stem-cell transplantation (HSCT). Limited data exist on early diagnosis and prevention of these complications. In this study, we retrospectively investigated the outcome and risk factors associated with thrombotic and bleeding complications in HSCT recipients.

From April 2004 to December 2010, 527 hematologic patients receiving HSCT (126 Auto-HSCT and 401 Allo-HSCT) were enrolled in the study, and their clinical manifestation and laboratory parameters were analyzed for evaluating the outcome of hemostatic complications and related risk factors. All analyses were carried out using the SAS program (version 8.1).

Overall incidence of thrombotic complication, which included 9 veno-occlusive diseases (VOD), 1 transplantation related thrombotic microangiopathy (TA-TMA), 1 pulmonary embolism (PE) and 1 deep vein thrombosis (DVT), was 2.3% (12 cases), and occurred in 11 patients who received allogeneic HSCT, and 1 patient who received autologous HSCT. The overall mortality after thrombotic events was 75% (9 cases) in all HSCT recipients with thrombotic complications. A total of 382 HSCT recipients (72.5%) developed bleeding events, including minor bleeding of 67.1% (210 cases), moderate bleeding of 28.4% (89 cases), and severe bleeding of 4.5% (14 cases) of all bleeding patients. By bleeding sites, 183 patients developed hemorrhagic cystitis (34.7% of all HSCT recipients). Other organs of hemorrhage involved skin or mucosa (46.5% of all HSCT recipients), gastrointestinal tract (21.1%), vagina (9.3%), and respiratory tract (1.3%). By risk factors analysis, CD33 mAb use and preparative regimen containing total body irradiation were significantly associated with the occurrence of thrombotic disorders (P<0.05). Thrombocytopenia, grade 2–4 acute graft-versus-host disease (aGVHD), allogeneic transplantation and infection were independent risk factors for bleeding complication (P<0.05). Polyomavirus and grade 2–4 aGVHD were risk factors for hemorrhagic cystitis (P<0.05). The number of hemorrhagic sites was significantly correlated with bleeding severity (P<0.05). Neither thrombotic nor bleeding disorders was correlated with age, disease category, gender, transplantation types, routine hemostatic parameters, or biochemical indicators (P>0.05). Survival rate was correlated with the bleeding site and intensity of bleeding disorders (P<0.01). Respiratory and gastrointestinal bleeding independently increased the mortality of HSCT recipients, while overal cumulative survival was decreased in patients with thrombotic complications. In addition, PAI-1 level in the HSCT recipients with thrombotic complications were significantly higher than other complications, including GVHD, infections, and preparative regimen-related toxicity (P<0.01).

Our study suggested that HSCT patients with thrombotic complications experienced high mortality while the HSCT recipients with bleeding disorders had high morbidity. Hence, early diagnosis and therapy of hemostatic complications are crucial to improve the prognosis of HSCT recipients.

No relevant conflicts of interest to declare.