难治复发急性白血病患者造血干细胞移植后感染相关死亡的分析  

Analysis of infection-related mortality after allogeneic hematopoietic stem cell transplantation in patients with refractory/relapse acute leukemia

作　　者：林韧[1] 孙竞[1] 毛玉景[1] 赵梦霞[1] 刘启发[1] 周红升[1] 黄芬[1] 宋晓玲[1] 李含[1] 马庆辉[1] 

机构地区：[1]南方医科大学南方医院血液科,广东广州510515

出　　处：《南方医科大学学报》2012年第9期1377-1380,共4页Journal of Southern Medical University

摘　　要：目的探讨难治复发急性白血病患者接受异基因造血干细胞移植（allo—HSCT）后感染相关死亡（IRM）的特点。方法回顾分析127例接受allo—HSCT的难治复发急性白血病患者的临床资料，统计感染相关死亡情况并分析危险因素。结果观察期内67例死亡。5年总生存率为（35．2±5．3）％，无病生存率为（30．8±5．6）％。28．3％（36／127）患者发生感染相关死亡。Ⅱ～Ⅳ。aGVHD（P=0．049，OR=3．017）和移植后IFI（P=0．032，OR=3．223）是IRM的独立危险因素。结论感染作为移植相关死亡的主要原因，相对于标危患者，在难治复发患者中占更高的比例。更多的关注严重GVHD后感染的预防和治疗力度是目前减少IRM的主要措施。Objective To investigate infection-related mortality （IRM） after allogeneic hematopoietic stem cell transplantation in patients with refractory/relapse acute leukemia. Methods We conducted a retrospective analysis of 127 patients with refractory/ relapse acute leukemia and investigated the incidence, causes and risk factors of IRM. Results Sixty-seven of the patients died after the transplantation. The 5-year overall survival and disease-free survival was （35.2±5.3）% and （30.8±5.6）% among these patients, respectively. IRM occurred in 28.3% （36/127） of the patients. Multivariate analysis showed that grade II-IV acute graft-versus-host diseases （aGVDH, P=0.049, OR=3.017） and post-transplant invasive fungal infection （P=0.032, OR=3.223） were independent risk factors of IRM. Conclusion As a common cause of transplant-related mortality, IRM is more frequent in cases of refractory/relapse acute leukemia than in cases with a standard risk profile, and effective prophylaxis and treatment of severe GVHD remain currently the primary measures for reducing post-transplant IRM.

关 键 词：难治复发急性白血病 造血干细胞移植 感染相关死亡 

分 类 号：R733.7[医药卫生—肿瘤]