异基因造血干细胞移植后迟发性出血性膀胱炎与移植供受体性别差异、抗胸腺细胞球蛋白应用及急性移植物抗宿主病有关  

Gender mismatch, use of anti-thymoglobulin, and occurrence of graft-versus-host disease in preparative regimen are associated with high incidence of post-engraftment hemorrhagic cystitis in allogeneic hematopoietic stem cell transplantation

作　　者：王苓[1] 唐暐[1] 王莹[1] 山洁慧[1] 窦汉波[1] 樊星[1] 胡炯[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院血液科,200025

出　　处：《白血病．淋巴瘤》2013年第7期410-414,共5页Journal of Leukemia & Lymphoma

摘　　要：目的 研究异基因造血干细胞移植过程中发生迟发性出血性膀胱炎（LOHC）的相关危险因素.方法 收集2000年1月至2010年12月共92例接受异基因造血干细胞移植的急性白血病患者（急性髓系白血病41例和急性淋巴细胞白血病51例）资料,回顾性分析与LOHC发生可能相关的危险因素.结果 所有患者中,43例进行人白细胞抗原（HLA）相合亲缘移植,49例进行无关供者移植,其中25例在移植后中位时间第35天（第20天至第65天）发生出血性膀胱炎（HC）.单因素分析结果提示以下因素与HC相关：无关供体移植、供受体性别不同（女供男）、含白消安的预处理方案、含吗替麦考酚酯的急性移植物抗宿主病（aGVHD）预防方案、抗胸腺细胞球蛋白（ATG）的应用、aGVHD的发生等；多因素分析结果仅提示三种独立因素可以提高HC的发生率,即供受体性别差异（P=0.001）、ATG的应用（P＜ 0.001）、aGVHD的发生（P=0.007）.综合此三项因素,将所有患者划分为具有不同HC发病风险的4组,HC发生率随着危险因素数目的增多依次提高,分别为（7.7±4.6）％、（22.9±7.1）％、（48.2±10.5）％、100.0％.结论 移植供受体性别的差异、ATG的应用以及aGVHD的发生三项因素为预测LOHC的独立预后因子,结合这些指标能够指导HC的危险预后分层.Objective To evaluate the risk factors of developing post-engraftment hemorrhagic cystitis （HC） in patients receiving allogeneic stem cell transplantation （allo-HSCT）.Methods Retrospective data was collected from 92 patients with acute leukemia （acute myeloid leukemia 41 and acute lymphoblastic leukemia 51） who underwent allo-HSCT from 2000 to 2010,and the association of pre-transplantation parameters with the incidence of post-engraftment HC was analyzed.Results Forty-three patients had HLA-matched donors and 49 had unrelated donors.Of these patients,25 developed HC at a median of 35 days （day ＋20 to ＋65） after allo-HSCT.In the univariate analysis,unrelated donor,gender mismatch （female donor to male recipient）,conditioning containing busulfan,graft-versus-host disease （GVHD）,prophylaxis with cyclosporine （CSA） ＋ methotrexate （MTX） ＋ mycophenolate mofetil （MMF）,use of anti-thymoglobulin （ATG） and development of GVHD were associated with increased incidence of HC.In the multivariate study,gender mismatch （P =0.001）,use of ATG （P 〈 0.001）,and GVHD （P =0.007） remain as independent factors for the increased risk of HC.More importantly,with these 3 factors,it is able to classify patients into 4 groups with risk of postengraftment HC at （7.7±4.6） %,（22.9±7.1） %,（48.2±10.5） %,and 100.0 %,respectively.Conclusion This retrospective study identified the gender mismatch,use of ATG in the preparation regimen,and aGVHD as important risk factors to predict the development of post-engraftment HC.Based on these risk factors,it is possible to classify patients into different risk groups for post-engraftment HC.Prospective study with a large cohort of patients is warranted to confirm the findings.Future clinical trial for HC prevention and treatment must be carried out on the intermediate and high-risk patients.

关 键 词：出血性膀胱炎 造血干细胞移植 异基因 危险因素 

分 类 号：R694[医药卫生—泌尿科学]