单倍体与亲缘全相合移植治疗恶性血液病的疗效分析  

Prognoses of patients with hematological malignancies after haploidentical or HLA-matched sibling hematopoietic stem cell transplantation

作　　者：张海燕[1] 龙冰[2] 刘小云[1] 李旭东[2] Zhang Haiyan;Long Bing;Liu Xiaoyun;Li Xudong(Department of General Practice, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510000, China)

机构地区：[1]中山大学附属第三医院全科医学科,广州510000 [2]中山大学附属第三医院血液科,广州510000

出　　处：《中华器官移植杂志》2018年第10期610-614,共5页Chinese Journal of Organ Transplantation

摘　　要：目的分析单倍体与全相合造血干细胞移植治疗恶性血液系统疾病的疗效,及影响移植后生存的相关危险因素。方法选取2011年10月至2017年7月行血缘相关异基因造血干细胞移植术的81例恶性血液病受者为研究对象,据移植方式分为单倍体移植组30例和全相合移植组51例。统计两组受者的造血重建时间、移植物抗宿主病(GVHD)发生率、总体生存率、无病存活率、复发率及非复发死亡率,并对可能影响总体存活率的危险因素进行多因素分析。结果81例受者均植入成功。移植后100 d单倍体移植、全相合移植组的Ⅱ~ⅣaGVHD的发生率分别为56.7%、11.8%,差异具有统计学意义(P=0.000)。单倍体移植、全相合移植受者移植后1年的cGVHD发生率分别为20.6%、45%,差异无统计学意义(P=0.341)。单倍体移植、全相合移植受者移植后2年的总体存活率分别为63.2%、78.4%(P=0.078),2年的无病生存率分别为54.8%、66.9%(P=0.159),移植后2年的复发率分别为25.9%、22.9%(P=0.465),移植后2年的非复发死亡率分别为24%、9.5%,差异均无统计学意义(P=0.118)。多因素分析结果显示,移植后复发、Ⅱ~Ⅳ度急性GVHD是影响生存率的危险因素,相对风险(RR)分别为6.671(95% CI 2.791~15.946)、3.073(95% CI 1.296~7.284)(P<0.05)。结论恶性血液病受者行单倍体移植的疗效与同胞全相合移植相似,移植后复发、发生重度急性GVHD对移植后受者的长期生存具有预后意义。Objective To compare the efficacy of haploidentical hematopoietic stem cell transplantation (HSCT) and HLA-identical transplantation for hematologic diseases, and analyze risk factors related to overall survival (OS). Methods There were 81 patients with hematological malignancies receiving Allo-HSCT from October, 2011 to July, 2017. The patients were divided into two groups: 30 patients undergoing haploidentical HSCT and 51 cases undergoing matched sibling donor HSCT (MSD-HSCT). Implantations of hematopoietie stem cells, incidence of graft versus host disease (GVHD), OS rate, disease free survival (DFS) rate, incidence of relapse and non-relapse-mortality were analyzed statistically. Multivariate analysis was used to analyze the risk factors related to OS. Results All patients achieved sustained engraftment. 100 days after Allo-HSCT, the cumulative incidence for Ⅱ-Ⅳ aGVHD had no significant difference between haplo-HSCT and MSD-HSCT (56.7% versus 11.8%, P=0.000). There was no significant difference in the 1-year cumulative incidence for cGVHD between haplo-HSCT and MSD-HSCT (20.6% versus 45%, P=0.341). The 2-year OS rate in patients receiving haplo-HSCT and MSD-HSCT was 63.2% and 78.4% respectively (P=0.078). The 2-year DFS rate in patients receiving haplo-HSCT and MSD-HSCT was 54.8% and 66.9% respectively (P=0.159). The 2-year relapse and non-relapse-mortality rate in patients receiving haplo-HSCT and MSD-HSCT was 25.9% and 24%, and 22.9% and 9.5% respectively. There were no statistically significant differences in relapse rate and mortality between two groups (P=0.465, 0.118). Multivariate analysis showed that relapse and Ⅱ-Ⅳ aGVHD were independent prognostic indictors for OS with relative risk 6.671 (95% CI 2.791-15.946) and 3.073 (95% CI 1.296~7.284)(P<0.05). Conclusion The therapeutic effects of haploidentical transplantation were similar to those of HLA-identical sibling transplantation. Relapse and Ⅱ-Ⅳ aGVHD after transplantation have prognostic significance for the long-term survival of transp

关 键 词：造血干细胞移植 血液病 预后 

分 类 号：R733[医药卫生—肿瘤]