Elevated Red Blood Cell Distribution Width as a Poor Prognostic Factor in Patients With Hematopoietic Stem Cell Transplantation.

Xiaojiong Jia,Hua Zou,Juan Lu,Long Zhang,Hongxu Wang,Yuan Zheng,Shifeng Huang,Si Cheng,Dijiao Tang

doi:10.3389/fonc.2020.565265

Abstract

Red cell distribution width (RDW), a measure of erythrocyte size variability, has been recently reported as an effective prognostic factor in critical illness. Hematopoietic stem cell transplantation (HSCT) has become the first choice of most patients with hematological malignancies. The aim of this study was to assess the changes of RDW in patients with HSCT and analyze the relationship between RDW and HSCT. In this study, we retrospectively enrolled 114 hematopoietic stem cell transplant patients during the period from 2015 to 2019. Logistic regression and Kaplan–Meier survival analysis were used for retrospective analysis. Multivariate analysis suggested that patients with elevated RDW (>14.5%) at three months post-transplantation have a poor clinical outcome compared with those with normal RDW ≤14.5% [odds ratio (OR) 5.12; P = 0.002]. Kaplan–Meier method analysis demonstrated that patients with elevated RDW levels (>14.5%) after hematopoietic stem cell transplantation experienced shorter progression-free survival compared to those with normal RDW levels (P = 0.008). Our study demonstrated that RDW could be an easily available and potential predictive biomarker for risk stratification in patients with HSCT. Further prospective studies are determined to confirm the prognostic value of RDW in HSCT patients.

Highlights

Hematopoietic stem cell transplantation (HSCT) refers to a well-recognized promising procedure that treats malignant hematological diseases such as leukemia and lymphoma and restores bone marrow function in cancer patients with dysfunctional hematopoiesis, such as aplastic anemia [1]
The present study aimed to clarify the prognostic value of baseline Red cell distribution width (RDW) in patients with hematopoietic stem cell transplantation
Our results demonstrated that elevated RDW levels was an independent predictor of disease progression or death after hematopoietic stem cell transplantation

Summary

Introduction

Hematopoietic stem cell transplantation (HSCT) refers to a well-recognized promising procedure that treats malignant hematological diseases such as leukemia and lymphoma and restores bone marrow function in cancer patients with dysfunctional hematopoiesis, such as aplastic anemia [1]. RDW in HSCT Prognosis carries a significant risk for treatment-related mortality, chemotherapy-induced toxic effects, early post-transplantation complications, and even graft-versus-host disease (GVHD), eventually contributing to the transplant failure [3]. For these reasons, there is an urgent need for novel, more effective biomarkers that can provide the opportunity for HSCT patients to receive risk-adapted therapies to improve their outcomes. It should be noted that many patients with hematopoietic stem cell transplantation are faced with several challenging risks, such as immune activation, nutritional deficiencies, impaired iron, and inadequate production of erythropoietin (EPO), and these risks may impact RDW, influencing the post-transplant reconstruction of the hematopoietic system [5, 12]. The clinical outcomes were analyzed to determine if there was an association between elevated RDW and long-term prognosis

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Conclusion