Risk Factors and Prognosis of Poor Graft Function after Allogeneic Hematopoietic Stem Cell Transplantation in Pediatric:A Retrospective Study

Yunyan He^1*Guanxiu Pang¹Xiaobo Wang²Wenguang Jia¹Mengchen Li¹Tianyuan Zhou¹Jiangming Luo^1*

• ¹First Affiliated Hospital, Guangxi Medical University, Nanning, China
• ²Sun Yat-sen University School of Science, Shenzhen, China

Abstract Introduction:Poor graft function (PGF) represents a serious and potentially life-threatening complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT); however, its etiological risk factors and prognostic implications remain inadequately defined within pediatric populations. Methods:A retrospective cohort study was conducted on 175 pediatric patients undergoing allo-HSCT between June 30, 2018, and December 31, 2022. Patients were stratified into PGF (n = 30) and good graft function (GGF, n = 145) groups. Multivariate logistic regression identified risk factors for PGF, while Cox proportional hazards models evaluated mortality-associated variables. Survival outcomes were analyzed using Kaplan-Meier curves. Results:Key findings encompass: (1) PGF Risk Factors: Multivariable analysis identified four independent predictors of PGF: age ≥ 10 years at transplantation (OR = 29.27, 95%CI: 5.70 -150.21, P < 0.001), HLA mismatch (OR = 4.11, 95%CI: 1.45-11.65, P = 0.008), cytomegalovirus (CMV) infection (OR = 7.64, 95%CI: 2.31-25.21, P = 0.001), and BK virus (BKV) infection (OR = 12.22, 95%CI: 2.49-59.89, P = 0.002); The model's predictive performance by ROC analysis yielded an AUC of 0.886 (95%CI: 0.83-0.94; P < 0.001). (2) Survival Analysis: the 4-year overall survival (OS) was profoundly inferior in the PGF cohort compared to the GGF cohort (49.4 ± 10.3% vs. 90.2 ± 2.5%, P < 0.001). (3) Predictors of Mortality: Cox regression identified PGF (HR = 2.39, 95%CI: 1.02-5.59, P = 0.044), acute graft-versus-host disease (grade I/II, HR = 3.43, 95%CI: 1.29-9.15, P = 0.014; grade III/IV, HR = 8.92, 95%CI: 3.19-24.96, P < 0.001), hemorrhagic cystitis (HR = 3.18, 95%CI: 1.37-7.39, P = 0.007), and severe pneumonia (HR = 4.42, 95%CI: 1.92-10.19, P < 0.001) as independent predictors of early mortality. Conclusion:Age ≥ 10 years at transplantation, HLA mismatch, CMV infection, or BK viremia identifies a high-risk cohort of pediatric allo-HSCT recipients who require intensified monitoring for PGF, underscoring an urgent need for effective preventive and therapeutic interventions.