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. 2020 Nov 30:8:584156.
doi: 10.3389/fped.2020.584156. eCollection 2020.

Modeling Long-Term Erythropoietic Recovery After Allogeneic Stem Cell Transplants in Pediatric Patients

Erik G J von Asmuth  1 , Alexander B Mohseny  1 , Hein Putter  2 , Marco W Schilham  1 , Arjan C Lankester  1
Affiliations

Modeling Long-Term Erythropoietic Recovery After Allogeneic Stem Cell Transplants in Pediatric Patients

Erik G J von Asmuth et al. Front Pediatr. .

Abstract

Long term erythropoietic reconstitution after allogeneic hematopoietic stem cell transplantation (alloHSCT) has not been extensively studied. We aimed to describe erythropoietic reconstitution as an indicator of long-term graft function by modeling hemoglobin levels during the first 3 years post HSCT in pediatric patients. We retrospectively included 414 patients and 11,957 measurements. The largest hemoglobin increase was at day 45 and levels reached a steady state at day 648 with a level of 7.48 mmol/L. In patients transplanted for hematological malignancies hemoglobin levels normalized faster (p < 0.0001). Increasing patient age correlated with faster recovery (p < 0.0001), while donor age had no influence. Conditioning, donor type and graft source did not influence recovery significantly. In the ABO mismatched group there was a transient negative effect on hemoglobin levels, and a delay in reticulocyte recovery (21 vs. 19 days; p = 0.012). In contrast, hemoglobin levels reached a higher plateau beyond 9 months in these patients (p < 0.0001). After alloHSCT, experiencing a CMV reactivation negatively affected reconstitution (p = 0.034), while EBV reactivations and acute graft vs. host disease did not. In summary, erythropoietic recovery was mainly influenced by patient factors and primary disease, and less influenced by donor factors.

Keywords: blood group (AB0); erythropoiesis; leukemia; pediatric stem cell transplantation; retrospective.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer EM declared a past co-authorship with one of the authors AL to the handling editor.

Figures

Figure 1
Figure 1
Overall hemoglobin recovery based on a mixed model.
Figure 2
Figure 2
(A) Haemoglobin recovery split by diagnosis, (B) Haemoglobin recovery split by myeloablative conditioning (MAC) vs. reduced intensity conditining (RIC), (C) Haemoglobin recovery split by donor type, with thallasemia and sickle-cell anemia excluded. (D) Haemoglobin recovery split by graft source. BM, Bone marrow; CB, Cord blood; PBSC, Peripheral blood stem cells.
Figure 3
Figure 3
(A) Haemoglobin recovery split by patient age at time of transplant. (B) Haemoglobin recovery split by donor age. (C) Haemoglobin recovery split by a major ABO mismatch. (D) Time to reticulocyte recovery split by a major ABO mismatch. (E) Number at risk for (D).
See this image and copyright information in PMC

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