To assess inflammation, endothelial damage, and platelet activation during platelet transfusion refractoriness (PTR) in pediatric patients with solid tumors. A cohort of 36 PTR and 38 Non-PTR pediatric patients with solid tumor was enrolled. Patients received standard chemotherapy and platelet transfusion according to guidelines. Levels of inflammatory mediators (IL-1β and IL-8, etc.), endothelial damage marker (vWF), and platelet activation markers (sP-selectin, sCD40L and RANTES) in pre-transfusion plasma were quantified by flow cytometry and ELISA. Associations with PTR, bleeding events, and progression-free survival (PFS) were analyzed by multivariable regression and Cox models. The PTR group showed significantly high levels of sP-selectin (14.1 vs. 6.0 ng/mL), sCD40L (293.4 vs. 206.2 pg/mL), vWF (231.7 vs. 162.3 µg/mL), IL-1β (67.4 vs. 38.9 pg/mL), and IL-8 (61.0 vs. 29.2 pg/mL). Multivariable analysis identified vWF (OR = 1.006), IL-1β (OR = 1.013), and IL-8 (OR = 1.021) as independent predictors of PTR. Predictive model combining these three markers with malignancy risk stratification significantly improved the predictive ability of PTR compared to clinical Model alone (AUC: 0.846 vs. 0.692, P = 0.003). Clinically, PTR patients had delayed platelet recovery (10.2 vs.7.3 days), higher bleeding (36.1% vs. 13.2%), and reduced 500-day PFS (41.5% vs. 55.2%). Elevated sP-selectin (≥ 10.1 ng/mL) and sCD40L (≥ 234.5 pg/mL) predicted bleeding. After adjustment for malignancy risk stratification, high sCD40L (HR = 3.853, 95% CI: 1.097–13.525) remained independently associated with lower PFS, whereas IL ‑ 8 showed a trend but was not statistically significant. Elevated IL-8 and sCD40L are novel predictors of PTR and survival prognostic in pediatric patients with solid tumors undergoing chemotherapy. IL-1β, IL-8 and vWF are identified as independent risk factors for PTR. sP-selectin and sCD40L are associated with increased bleeding risk, and high sCD40L is independent predictors of lower 500-day PFS.
Zhou et al. (Fri,) studied this question.