亲缘HLA不相合与无关HLA全相合供者造血干细胞移植治疗血液肿瘤疗效比较  

Comparison of clinical efficacy between HLA-mismatched related and HLA-matched unrelated donor hematopoietic stem cell transplantation for hematopoietic malignancies

作　　者：于嗣俭 戴敏[1] 孙竞[1] 范志平[1] 黄芬[1] 张钰[1] 江千里[1] 周红升[1] 徐丹[1] 孟凡义[1] 刘启发[1] 

机构地区：[1]南方医科大学南方医院血液科,广州510000

出　　处：《中华血液学杂志》2014年第9期826-830,共5页Chinese Journal of Hematology

基　　金：国家863课题分题（2011AA020105）;卫生公益性行业科研专项（201202017）;广州市科技计划项目（201154300104）;国家自然科学基金面上项目（81270647）;国家自然科学基金（81300445）

摘　　要：目的 比较亲缘HLA不相合和无关HLA全相合供者造血干细胞移植（HSCT）对血液肿瘤患者的疗效.方法 回顾性分析2002年6月至2012年12月82例接受亲缘HLA不相合和92例接受无关HLA全相合供者HSCT的血液肿瘤患者,比较二组患者移植后造血重建、移植物抗宿主病（GVHD）、复发和生存情况.结果 两组患者在年龄、性别、原发疾病类型、移植前疾病状态差异均无统计学意义（P＞0.05）.亲缘组和无关组急性GVHD、Ⅲ～Ⅳ度急性GVHD发生率分别62.2％和54.3％、15.9％和9.8％（P=0.295,P=0.229）;慢性GVHD、广泛型慢性GVHD发生率分别为28.4％和45.1％、9.0％和12.2％（P=0.036,P=0.525）;两组GVHD致死率分别为8.5％和10.9％（P=0.60）.两组10年累积复发率分别为（21.5±5.7）％和（37.6±7.3）％（P=0.194）,10年总生存率分别为（50.1±6.1）％和（50.5±6.7）％（P=0.501）、无病生存率分别为（48.8±6.1）％和（46.3±6.2）％（P=0.873）.结论 亲缘HLA不相合供者与无关HLA全相合供者HSCT对血液肿瘤患者具有同等的疗效和安全性,在无HLA全相合同胞供者的情况下,亲缘HLA不相合移植比无关HLA全相合移植具有供者来源不受限制和根据疾病需要及时选择移植时机的优势.Objective To compare the clinical efficacy of HLA-mismatched related donor （MRD） and HLA-matched unrelated donor （MUD） hematopoietic stem cell transplantation （HSCT） for hematopoietic malignancies.Methods 174 patients with hematopoietic malignancies undergoing allogeneic HSCT （allo-HSCT） （82 from MRD and 92 from MUD） between June 2002 and December 2012 were enrolled in this retrospective study.Hematopoietic engraftment,graft versus host disease （GVHD）,relapse,overall survival （OS） and disease-free survival （DFS） were compared between MRD and MUD group.Results There was no significant difference between MRD and MUD group in terms of age,gender,disease type and disease status before transplantation （all P＞0.05）.The incidence of Ⅰ-Ⅳ acute GVHD （aGVHD） was 62.2％ and 54.3％ in MRD and MUD group （P=0.295）; the incidence of Ⅲ-Ⅳ aGVHD between the two groups was 15.9％ and 9.8％ （P=0.229）.The incidence of chronic GVHD （cGVHD） was 28.4％ and 45.1％ in MRD and MUD group （P=0.036）,but there was no significant difference in the incidence of extensive cGVHD between the two groups （9.0％ vs 12.2％,P=0.525）.The mortality of GVHD was 8.5％ and 10.9％ in MRD and MUD group （P=0.605）.The 10-year OS and DFS were（50.1 ±6.1）％ and （48.8±6.1）％ in MRD group,compared with （50.5±6.7）％ and （46.3±6.2）％ in MUD group （P=0.501,P=0.873,respectively）.The 10-year cumulative relapse rate was（21.5±5.7）％ and （37.6±7.3）％ in MRD and MUD group （P=0.194）.Conclusions MRD is equivalent to MUD in efficacy and safety.Without HLA-matched relned donors,MRD is superior to MUD because donor source is unlimited and transplantation could be made promptly according to disease status.

关 键 词：人类白细胞抗原 供者 治疗结果 造血干细胞移植 

分 类 号：R733[医药卫生—肿瘤]