Impact of hyperhydration on fluid overload and hematopoietic cell transplant after post-transplant cyclophosphamide-based graft-versus-host-disease prophylaxis

被引：0

作者：

Samuels, Diana T. ^{[1
]}

Yao, Janny M. ^{[1
]}

Samara, Yazeed ^{[2
]}

Yang, Dongyun ^{[3
]}

Mokhtari, Sally ^{[4
]}

Tiemann, Katrin ^{[4
]}

Otoukesh, Salman ^{[2
]}

Arslan, Shukaib ^{[2
]}

Pourhassan, Hoda ^{[2
]}

Wu, Stephanie ^{[5
]}

Blackmon, Amanda ^{[2
]}

Agrawal, Vaibhav ^{[2
]}

Amanam, Idoroenyi ^{[2
]}

Ali, Haris ^{[2
]}

Salhotra, Amandeep ^{[2
]}

Aldoss, Ibrahim ^{[2
]}

Ball, Brian ^{[2
]}

Koller, Paul ^{[2
]}

Aribi, Ahmed ^{[2
]}

Sandhu, Karamjeet ^{[2
]}

Pullarkat, Vinod ^{[2
]}

Artz, Andrew ^{[2
]}

Smith, Eileen ^{[2
]}

Stewart, Forrest ^{[2
]}

Becker, Pamela ^{[2
]}

Stein, Anthony ^{[2
]}

Marcucci, Guido ^{[2
]}

Forman, Stephen J. ^{[2
]}

Nakamura, Ryotaro ^{[2
]}

Al Malki, Monzr M. ^{[2
]}

机构：

[1] City Hope Natl Med Ctr, Dept Pharm, Duarte, CA USA

[2] City Hope Natl Med Ctr, Dept Hematol & Hematopoiet Cell Transplantat, Duarte, CA 91010 USA

[3] City Hope Natl Med Ctr, Dept Computat & Quantitat Med, Div Biostat, Duarte, CA USA

[4] City Hope Natl Med Ctr, Dept Clin & Translat Project Dev, Duarte, CA USA

[5] City Hope Natl Med Ctr, Div Cardiol, Dept Internal Med, Duarte, CA USA

来源：

FRONTIERS IN IMMUNOLOGY | 2025年 / 16卷

关键词：

allogeneic hematopoietic cell transplantation; post-transplant cyclophosphamide; hyperhydration; hemorrhagic cystitis; fluid overload; fluid retention; fluid toxicity; weight gain; BONE-MARROW-TRANSPLANTATION; HIGH-DOSE CHEMOTHERAPY; HEMORRHAGIC CYSTITIS; SINGLE-AGENT; PREVENTION; BUSULFAN; MESNA;

D O I：

10.3389/fimmu.2025.1543099

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Introduction Hemorrhagic cystitis (HC) is an early complication after hematopoietic cell transplant (HCT) with post-transplant cyclophosphamide (PTCy). Hyperhydration can reduce HC, but may lead to fluid overload (FO), which has been associated with higher non-relapse mortality (NRM) after HCT. Methods The objectives of this study were to grade FO between days 3 and 8 based on weight gain, diuretic therapy, and FO-related organ dysfunction and analyze the impact of FO on non-relapse mortality (NRM) and subsequently on overall survival (OS) of patients undergoing HCT with PTCy-based GvHD prophylaxis. Results Two hundred seventy-five patients who received PTCy at City of Hope from 2009 to 2018 were included. A majority, 270 (98%) patients were diagnosed with early FO from day 3-8 post HCT, of whom 248 (92%) experienced mild to moderate (grade 1-2) FO, and 22 (8%) experienced severe (grade 3-4) FO. Day 100 NRM was significantly higher in patients with grade 3-4 FO compared to patients with grade 0-1 (59.1 vs 1.7%, CI: 0.006-0.053p<0.001) and grade 2 (59.1 vs 8.8%, CI: 0.043-0.178, p<0.001) FO. At 2 years, OS and DFS were significantly lower in patients who experienced grade 3-4 FO compared to patients who had grade 0-1 FO (31.8% vs 68.2%, CI: 0.616-0.755, p<0.001) and grade 2 FO (31.8% vs 62.5%; CI: 0.527-0.741, p<0.001). Additionally, each 5% weight gain from baseline was associated with higher NRM (HR=1.91, 95%CI: 1.64-2.23, p<0.001). Conclusion Almost all patients undergoing hyperhydration for PTCy-induced HC will present with FO. Grade 3-4 FO is uncommon and associated with poor clinical outcomes. Weight gain could be used as an early and possibly modifiable indicator of FO.

引用

页数：11

共 26 条

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