82例恶性血液病患者异基因造血干细胞移植后复发的危险因素分析  

Analysis of risk factors for relapse of 82 patients with hematologic malignancies after allogeneic hematopoietic stem cell transplantation

作　　者：余正平[1] 丁家华[1] 陈宝安[1] 吴芬[1] 高冲[1] 孙耘玉[1] 程坚[1] 赵刚[1] 王骏[1] 李玉峰[2] 丁邦和[3] 钱军[3] 

机构地区：[1]东南大学附属中大医院血液科,南京 210009 [2]淮安市第一人民医院血液科 [3]镇江市第一人民医院血液科

出　　处：《中华肿瘤杂志》2011年第4期283-286,共4页Chinese Journal of Oncology

摘　　要：目的探讨异基因造血干细胞移植（allO-HSCT）后复发的危险因素。方法总结82例接受allo—HSCT治疗的血液病患者的临床资料，分析供受者年龄、供受者性别、供受者血型异同、供者类型、疾病状态、HTA配型、预处理方案、移植物抗宿主病（GVHD）的有无、回输CD34＋细胞数量、有无巨细胞病毒感染等与移植后复发的关系。结果16例患者在移植后2～28个月复发。单因素分析结果显示，疾病状态（P=0．013）、疾病诊断到移植的时间（P=0．042）、预处理方案（P=0．046）、急性GVHD（P=0．022）、慢性GVHD（P=0．002）与allO—HSCT后复发有关。Cox多因素回归分析结果显示，疾病状态（OR=2．58，95％CI为1．26～5．01）、疾病诊断到移植的时间（OR：1．98，95％CI为1．11～3．63）和慢性GVHD（OR=3．74，95％CI为1．96～7．97）是allo—HSCT后复发的独立影响因素。结论复发仍是allo－HSCT失败的首要原因，疾病状态、疾病诊断到移植的时间以及无慢性GVHD是移植后复发的主要危险因素。Objective To explore the risk factors for relapse after allogeneic hematopoietic stem cell transplantation （allo-HSCT） and the measures of prophylaxis and treatment. Methods We summarized the clinical data of 82 patients with hematologic malignancies who were treated in our hospital from August 2003 to December 2008. Factors including age, sex, ABO blood group disparity of donor and recipient as well as the type of donor, status of disease, HLA-match, conditioning regimen, whether or not having developed acute GVHD and chronic GVHD, infusion number of CD34＋ cells, relationship between CMV infection and relapse post-transplantation were considered and analyzed. Results Single factor analysis indicated that there were five independent risk factors related with the disease relapse （ P 〈 0.05 ）, including status of disease, time of diagnosis to transplantation, acute graft versus host disease （aGVHD）, conditioning regimen, and chronic graft versus host disease （cGVHD）. Simultaneously, the type of donor was a substantial factor （P 〈 0.01 ）, determined by multi-factor Cox regression analysis. Cox regression analysis determined that disease status （ OR = 2. 58, 95% CI 1. 26-5. 01, P = 0. 01 ）, time from diagnosis to treatment （OR= 1.98, 95% CI 1.11-3.63, P =0. 025） and cGVHD （OR=3.74, 95% CI 1.96-7.97, P 〈 0.001 ） were major factors for relapse of the patients who had undergone transplantation. Conclusions Relapse remains the primary cause of failure after allo-HSCT. Status of disease, time from diagnosis to treatment and not cGVHD are the major risk factors. Effective prevention and treatment of relapse after engraftment can improve the efficacy of HSCT.

关 键 词：异基因造血干细胞移植 血液肿瘤 复发 移植物抗宿主病 移植物抗白 血病 

分 类 号：R733[医药卫生—肿瘤]