供受体HLA配型位点不相合的脐血移植对白血病患儿预后的影响  

Effect of donor and recipient HLA mismatched locus on the prognosis of childhood with leukemia after umbilical cord blood transplantation

作　　者：刘露 李泊涵 张晖 姚艳华[1] 程生钦 吴水燕[1] 李捷[1] 卢俊[1] 肖佩芳[1] 胡绍燕[1] Liu Lu;Li Bohan;Zhang Hui;Yao Yanhua;Cheng Shengqin;Wu Shuiyan;Li Jie;Lu Jun;Xiao Peifang;Hu Shaoyan(Department of Hematology,Children′s Hospital of Soochow University,Su Zhou 215000,China)

机构地区：[1]苏州大学附属儿童医院血液科,苏州215000

出　　处：《中华医学杂志》2024年第27期2521-2528,共8页National Medical Journal of China

基　　金：国家自然科学基金(82170218、81970163)

摘　　要：目的探究供受体人类白细胞抗原(HLA)配型位点不相合的脐血移植对白血病患儿预后的影响。方法回顾性纳入苏州大学附属儿童医院2016年1月至2023年6月使用单份非亲缘脐血行首次造血干细胞移植的白血病患儿的临床资料,并收集供受体高分辨HLA-A、HLA-B、HLA-C、HLA-DRB1和HLA-DQB1共5个位点的基因信息。在每个位点中,按照2条基因信息是否相合,分为相合组(2条基因完全匹配)和不相合组(有1条基因不匹配),在不同位点中,分别比较相合组与不相合组急性移植物抗宿主病(aGVHD)发生、复发、非复发死亡及生存的差异。使用多因素Cox回归分析总生存率的影响因素,使用Fine-Gray竞争风险模型分析其他结局事件的影响因素。结果共纳入100例患儿,男55例,女45例,移植时患儿年龄[M(Q_(1),Q_(3))]为3.9(2.0,6.5)岁。HLA-A位点的相合组55例,不相合组45例,相合组5年非复发死亡率(NRM)低于不相合组(P=0.024),相合组移植后100 d内aGVHD累积发生率低于不相合组(P=0.017),其他结局事件组间差异均无统计学意义(均P>0.05);HLA-B位点相合组70例,不相合组30例,相合组5年累计复发率高于不相合组(P=0.027),其他结局事件组间差异均无统计学意义(均P>0.05);HLA-C位点相合组79例,不相合组21例,2组结局事件差异均无统计学意义(均P>0.05);HLA-DRB1位点相合组73例,不相合组27例,相合组5年总生存率高于不相合组(P=0.036),相合组5年累积复发率高于不相合组(P=0.028),相合组5年NRM低于不相合组(P=0.008),相合组移植后100 d内aGVHD累积发生率低于不合组(P=0.010),其他结局事件组间差异均无统计学意义(均P>0.05);HLA-DQB1位点相合组68例,不相合组32例,2组结局事件差异均无统计学意义(均P>0.05)。HLA-A位点不相合组发生aGVHD的风险高于HLA-A位点相合组(HR=1.25,95%CI:1.12~1.38);HLA-B位点不相合组复发的风险低于HLA-B位点相合组(HR=0.77,95%CI:0.63~0.91);与HLA-DRB1位�Objective The aim of the study was to investigate the impact of the sites of high-resolution human leukocyte antigen(HLA)mismatch on the prognosis of children with leukemia undergoing umbilical cord blood transplantation(UCBT).Methods Clinical data and high-resolution HLA-A,HLA-B,HLA-C,HLA-DRB1 and HLA-DQB1 locus gene information were collected in the children who underwent the UCBT for the first time at Children′s Hospital of Soochow University between January 2016 and June 2023.In each locus,according to whether the two genes were compatible,they were divided into a compatible group(two genes were perfectly matched)and a non-compatible group(one gene was not matched).In different loci,the differences in occurrence,recurrence,non-recurrence death and survival of acute graft versus host disease(aGVHD)were compared between the two groups.Multivariate Cox regression was employed to analyzed the influencing factors for overall survival rate,and Fine-Gray proportional hazards model was employed to analyze the influencing factors of other outcome events.Results A total of 100 patients were enrolled(55 males and 45 females),whose age[M(Q_(1),Q_(3))]at the time of transplantation was 3.9(2.0,6.5)years.There were 55 cases in the HLA-A matched group and 45 cases in the mismatched group.The 5-year non-recurrence mortality(NRM)in the HLA-A matched group was lower than that in the mismatched group(P=0.024).The cumulative incidence of aGVHD within 100 days after transplantation in the HLA-A matched group was lower than that in the mismatched group(P=0.017),and there were no statistically significant differences in other outcome events between the groups(all P>0.05).There were 70 cases in the HLA-B matched group and 30 cases in the mismatched group.The 5-year cumulative recurrence rate in the HLA-B matched group was higher than that in the mismatched group(P=0.027).There were 79 cases in the HLA-C matched group and 21 cases in the mismatched group,and there were no statistically difference in the outcome events between the g

关 键 词：白血病 HLA配型 脐带血移植 儿童 

分 类 号：R733.7[医药卫生—肿瘤]