异基因外周血干细胞输注后24小时内发热病因分析

Etiological analysis of fever in the first 24 hours following allogeneic peripheral stem cell transfusion

目的探讨接受异基因外周血干细胞输注后24h内患者新出现发热的发生率和病因，并分析相关的危险因素。方法回顾性分析北京大学人民医院血液病研究所2009年10月至2010年8月异基因造血干细胞移植治疗的114例患者中，输注外周血干细胞24h内新出现发热患者的临床资料。应用多因素logistic回归分析输注相关性发热的危险因素。结果114例异基因外周血干细胞输注后24h内共有32例（28．1％）患者出现发热，均为人类白细胞抗原（HLA）配型不相合的亲缘间移植。最高体温平均值为39．0（37．6-40．4）oC；出现发热的中位时间为输注后的2．5（0-18．0）h；体温达到峰值的中位时间为输注后7．8（3．5-23．0）h。发热病因分析：6例为感染性病因；26例排除溶血后归为输注相关性发热。多因素分析发现女性供者及供者采集当日外周血白细胞计数高是输注相关性发热的危险因素。结论异基因外周血细胞输注后24h内新出现的发热均发生在HLA配型不相合亲属间移植患者，大多数与输注关系明显，无明确感染灶，其危险因素是女性供者及供者采集当日外周血白细胞高计数。

Objective To investigate the incidence and pathogenesis of fever within the first 24 hours following allogeneic peripheral stem cell transfusion and to analyze the associated risk factors. Methods Totally 114 patients received allogeneie hematopoietic stem cell transplantation （allo-HSCT） between October 2009 and August 2010 were enrolled and clinical data of febrile patients within 24 hours following peripheral stem cell transfusion were retrospectively analyzed. Multivariate logistic regression analysis was performed to identify the risk factors for transfusion related fever. Results Thirty-two （28. 1% ） out of the 114 patients had a fever within 24 hours after allo-HSCT. All of them were human leukocyte antigen （HLA） mismatch transplantation. The median time of the temperature elevated was 2. 5 （0-18.0） hours after the infusion with a median time of the peak of 7. 8（3.5-23.0） hours after the infusion. Fever was attributed to definite infection in 6 patients and no definite infection in the remaining 26 patients. None of them were hemolytic, which was attributed to transfusion related fever. Multivariate analysis showed that female donor and high count of peripheral leukocyte of donor peripheral blood were significant predictors for transfusion related fever. Conclusions Most of post-infusion fever within 24 hours after HLA mismatch related transplantation has no identifiable infectious focus. The risk factors for transfusion related fever are female donor and high number of peripheral leukocyte of donor blood.