异基因造血干细胞移植治疗41例重型再生障碍性贫血疗效分析  

Outcome analysis of allogeneic hematopoietic stem cell transplantation for 41 patients with severe aplastic anemia

作　　者：周健[1] 张龚莉 符粤文[1] 朱兴虎[1] 梁利杰[1] 祖璎玲[1] 王倩[1] 喻凤宽[1] 韩利杰[1] 房佰俊[1] 魏旭东[1] 宋永平[1] 

机构地区：[1]郑州大学附属肿瘤医院、河南省肿瘤医院血液科、河南省血液病研究所,450003

出　　处：《中华血液学杂志》2016年第8期661-665,共5页Chinese Journal of Hematology

摘　　要：目的评价异基因造血干细胞移植（allo—HSCT）治疗重型再生障碍性贫血（SAA）患者的疗效。方法回顾性分析2001年10月至2015年5月接受allo—HSCT治疗的4l例SAA患者的临床资料。其中男27例，女14例，中位年龄为17（2-43）岁。其中同胞相合移植24例，无关供者移植17例。结果38例患者移植后获得造血重建，造血重建率为92．68％。可评估患者的中性粒细胞和血小板的中位植入时间分别为16（10-57）d和20（9-83）d。13例发生急性移植物抗宿主病（aGVHD），8例发生慢性移植物抗宿主病，5例发生移植物排斥反应。中位随访27（3-154）个月，预期3年总生存（OS）率为（75．1±8．3）％。10例患者死亡，移植相关死亡率为24．39％。多因素分析结果显示：移植后发生Ⅱ-Ⅳ度aGVHD[P=0．018，OR=27．481（95％C12．377-392．636）]和侵袭性真菌病[P=0．021，OR=21．364（95％CI 1．732-354．185）]为影响SAA患者allo—HSCT后OS的独立危险因素。结论同胞相合供者和HLA匹配的无关供者allo-HSCT是治疗SAA患者的有效手段，Ⅱ-Ⅳ度aGVHD和侵袭性真菌病与移植后OS率较低有关。Objective To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation （allo-HSCT） for patients with severe aplastic anemia （SAA）. Methods A retrospective study was conducted in 41 SAA patients received allo-HSCT from Oct. 2001 to May 2015. There were 27 males and 14 females with median age of 17 （2-43） years old. Of them, 24 received matched sibling donor HSCT, 17 received unrelated donor transplantation. Results Hematopoiesis reconstitution was achieved in 38 patients （92.68%）. Median time of neutrophils and platelets implantation was 16 （10-57） d and 20 （9-83） d in evaluable patients, respectively. Acute GVHD occurred in 13 cases, chronic GVHD in 8 cases, and graft rejection in 5 cases. Median follow-up time was 27 （3-154） months. The prospective OS for 3 years was （75.1±8.3）%. Transplantation related mortality was 24.39% （10 cases）. Multivariate analysis revealed that grade Ⅱ-Ⅳ aGVHD [P=0.018, OR=27.481 （95% CI 2.377-392.636） ] and invasive fungal disease [P=0.021, OR=21.364 （95% CI 1.732-354.185） ] were independent risk factors of OS for SAA patients after allo-HSCT. Conclusion Allo-HSCT is an efficient and safe therapy for the patients with SAA, not only for patients with HLA matched sibling donor, but also for those with only HLA matched unrelated donor available. Grade 1I- IV aGVHD and invasive fungal disease were associated with lower OS rate.

关 键 词：贫血 再生障碍性 造血干细胞移植 移植物抗宿主病 治疗结果 

分 类 号：R556.5[医药卫生—血液循环系统疾病]