异基因造血干细胞移植患者行治疗性血浆置换不良反应的影响因素分析OA

Objective To investigate the incidence and independent risk factors of adverse events(AEs)associated with therapeutic plasma exchange(TPE)in patients undergoing allogeneic hematopoietic stem cell transplantation(allo-HSCT),and to provide evidence to support the safe use of TPE in clinical practice.Methods This retrospective study in-cluded 167 allo-HSCT recipients who underwent a total of 385 TPE procedures between March 2022 and December 2023.Patients were divided into two groups according to the occurrence of TPE-related AEs.Baseline characteristics,plasma ex-change parameters,and clinical features were collected.Univariate analysis and multivariable Firth logistic regression were performed to identify independent risk factors for AEs.Results A total of 385 TPE procedures were performed in 167 allo-HSCT patients,and 33 patients(19.8%)experienced TPE-related AEs.Among the 33 patients who experienced AEs,al-lergic reactions were the most common(n=18,54.5%),followed by blood pressure fluctuations(n=11,33.3%)and hy-pocalcemia(n=4,12.1%).Most AEs were classified as grade II(n=23,69.7%),and no grade IV(fatal)events were observed.Univariate analysis demonstrated a significant difference in the incidence of AEs among different hematocrit(HCT)categories(<20%,20%-30%,and>30%)(Fisher's exact test,P=0.022).Although the overall difference was statistically significant,none of the pairwise comparisons remained significant after Bonferroni correction(adjusted P>0.0167).Multivariable Firth logistic regression identified higher HCT levels,analyzed as a continuous variable(OR=1.07,95%CI:1.01-1.13,P=0.020),and TPE performed for cytokine release syndrome(CRS)(OR=9.21,95%CI:1.25-78.00,P=0.030)as potential independent risk factors for TPE-related AEs.Receiver operating characteristic(ROC)curve analysis showed that HCT had an AUC of 0.67(95%CI:0.57-0.77)for predicting AEs,with an optimal cutoff value of 24.5%,a sensitivity of 60.6%,and a specificity of 75.4%.Using this cutoff,the AEs rate was significantly higher in patients with HCT≥24.5%than in those with HCT<24.5%(37.7%vs 11.4%,P<0.001).Conclusion A-mong allo-HSCT patients receiving TPE,allergic reactions were the predominant AEs.Higher HCT levels and TPE per-formed for CRS may be associated with an increased risk of AEs.HCT≥24.5%may help identify patients requiring inten-sified monitoring,although its discriminatory ability is moderate(AUC=0.67)and it should not be used as a standalone criterion for clinical decision-making.Findings regarding the CRS subgroup require validation in larger cohorts.Optimizing extracorporeal circuit priming and strengthening peri-procedural monitoring may help improve the safety of TPE.