非血缘造血干细胞移植中HLA-A、HLA-B、HLA-DRB1高分辨位点匹配程度与预后的相关性分析  

The impact of HLA-A,HLA-B,HLA-DRB1 high-resolution matching on the prognosis of hematopoietic stem cell transplantation from unrelated donors：a retrospective report

作　　者：樊星[1] 王苓[1] 唐暐[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骨髓移植病区,200025

出　　处：《白血病．淋巴瘤》2013年第10期589-592,共4页Journal of Leukemia & Lymphoma

基　　金：2012年上海高校青年教师培养资助计划（82013010700002）

摘　　要：目的 探讨非血缘造血干细胞移植中HLA是否完全匹配对疾病预后的影响.方法 回顾性分析81例进行非血缘造血干细胞移植治疗的恶性血液病（包括白血病、骨髓增生异常综合征、淋巴瘤）患者资料.分为HLA高分辨全相合组（53例）与HLA非全相合组（28例）.比较两组患者的移植后总生存（OS）、治疗相关死亡率（TRM）、复发率（RR）、移植物抗宿主病（GVHD）发生率,并进一步深入讨论原因.结果 81例患者的中位随访时间为11.9个月（0.3～ 57.4个月）.HLA全相合组与HLA非全相合组间OS率（66.0％比46.4％,P=0.031）、TRM（17.0％比42.9％,P=0.017）差异均有统计学意义,而RR差异无统计学意义（14.3％比32.1％,P=0.111）.经多因素分析显示,HLA全相合与否是TRM独立预后因素,但非OS的独立预后因素.HLA全相合组与HLA非全相合组间急性GVHD（22.9％比40.9％,P=0.122）与慢性GVHD的发生率（40.0％比46.7％,P=0.655）差异无统计学意义,而重度急性GVHD发生率（4.2％比31.8％,P=0.005）差异有统计学意义.结论 非亲缘造血干细胞移植中HLA-A、HLA-B、DRB1位点高分辨匹配程度影响OS、TRM及重度急性GVHD发生率,并不影响RR、急性GVHD与慢性GVHD整体发生率.Objective To assess the impact of HLA-A,HLA-B,HLA-DRB1 matching on the prognosis of hematopoietic stem cell transplantation from unrelated donors.Methods A total of 81 patients with hematological malignancies including leukemia,myelodysplastic syndrome（MDS）and lymphoma who underwent hematopoietic stem cell transplantation from unrelated donors from 2007 to 2012 in our department were included in this retrospective analysis.Patients were classified into HLA match group（n=53）and HLA mismatch group（n=28）according to the HLA high-resolution matching.The overall survival （OS）,treatmentrelated mortality（TRM）,relapse rate（RR）,graft-versus-host disease（GVHD）incidence were analyzed.Results The 81 patients were analyzed with a median follow-up of 11.9 months（0.3 to 57.4 months）.The OS （66.0％vs 46.4％,P=0.031）and TRM（17.0％vs 42.9％,P=0.017）were significantly different between the HLA match group and HLA mismatch group,while the RR had no significant difference（14.3％vs 32.1％,P=0.111）.Multivariate analysis showed HLA matching was an independent prognostic factor of TRM,but not OS.There＇s no significant difference of aGVHD（22.9％vs 40.9％,P=0.122）and cGVHD （40.0％vs 46.7％,P=0.655）incidence between the two groups,but the incidence of severe aGVHD in HLA match group were much lower（4.2％vs 25.0％,P=0.005）than HLA mismatch group.Conclusion the high-resolution matching of HLA-A,-B,DRB1 affect OS,TRM and the incidence of severe aGVHD in unrelated hematopoietic stem cell transplantation,but not affect RR,the incidence of aGVHD and cGVHD.

关 键 词：造血干细胞移植 非血缘供者 HLA匹配 生存分析 移植物抗宿主病 

分 类 号：R733[医药卫生—肿瘤]