脾肿大对慢性粒-单核细胞白血病异基因造血干细胞移植预后的影响  

Impact of splenomegaly on outcomes of allogeneic hematopoietic stem cell transplantation in patients with chronic myelomonocytic leukemia

作　　者：赵晨 黄晓军[1,2] 赵晓甦[1] 王昱[1,2] 闫晨华[1] 许兰平[1] 张晓辉[1] 刘开彦[1] 孙于谦[1] Zhao Chen;Huang Xiaojun;Zhao Xiaosu;Wang Yu;Yan Chenhua;Xu Lanping;Zhang Xiaohui;Liu Kaiyan;Sun Yuqian(Peking University People’s Hospital,Peking University Institute of Hematology,National Clinical Research Center for Hematologic Disease,Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing 100044,China;Hematology Collaborative Innovation Center,Peking University,Beijing 100871,China)

机构地区：[1]北京大学人民医院、北京大学血液病研究所、国家血液系统疾病临床医学研究中心、造血干细胞移植北京市重点实验室,100044 [2]血液学协同创新中心,北京大学,100871

出　　处：《中华血液学杂志》2020年第4期308-312,共5页Chinese Journal of Hematology

摘　　要：目的:探讨脾肿大对慢性粒-单核细胞白血病(CMML)异基因造血干细胞移植(allo-HSCT)预后的影响。方法:对2004年至2018年在北京大学血液病研究所接受allo-HSCT后的25例CMML患者进行回顾性分析,根据预处理前2周是否伴有脾脏肿大分为脾肿大组和非脾肿大组,比较两组患者在植入、移植物抗宿主病(GVHD)、复发以及生存方面的差异。结果:①脾肿大组15例(男8例,女7例),中位年龄45(23~61)岁;非脾肿大组10例(男、女各5例),中位年龄39(12~56)岁。两组患者基线特征差异无统计学意义(P>0.05)。②脾肿大组、非脾肿大组粒细胞植入率分别为93.3%(14/15)、100.0%(10/10),中位植入时间分别为17(11~20)d、14(11~18)d(χ^2=5.303,P=0.021);脾肿大组、非脾肿大组血小板植入率分别为80.0%(12/15)、90.0%(9/10)(P=0.212),中位植入时间分别为17(12~33)d、15(12~19)d(χ^2=0.470,P=0.493)。③脾肿大组5例发生急性GVHD(Ⅰ/Ⅱ度4例,Ⅲ/Ⅳ度1例),非脾肿大组6例发生急性GVHD(Ⅰ/Ⅱ度5例,Ⅲ/Ⅳ度1例)(χ^2=0.204,P=0.652)。脾肿大组、非脾肿大组移植后100 d的急性GVHD累积发生率分别为33.3%(95%CI 14.9%~51.7%)、20.0%(95%CI 2.8%~37.2%)(P=0.635)。脾肿大组5例发生慢性GVHD(广泛型3例),非脾肿大组未发生慢性GVHD(P=0.041)。④脾肿大组、非脾肿大组3年累积复发率分别为(42.7±2.6)%、(11.1±1.2)%(χ^2=1.824,P=0.122),3年总生存率分别为(61.5±13.5)%、(68.6±15.1)%(χ^2=0.351,P=0.554),3年无白血病生存率分别为(56.3±14.8)%、(80.0±17.9)%(χ^2=1.148,P=0.284)。结论:脾肿大可致CMML患者allo-HSCT后粒细胞植入延迟,对生存及复发无影响。Objective To retrospectively analyzed the impact of splenomegaly on outcomes in patients with chronic myelomonocytic leukemia(CMML)receiving allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods Clinical data of 25 patients with CMML receiving allo-HSCT at Peking University Institute of Hematology from 2004-2018 were retrospectively analyzed.Engraftment,graft versus host disease(GVHD),relapse,survival were compared between patients with or without splenomegaly before transplantation.Results There were 15 splenomegaly patients including 8 males and 7 females with a median age of 45(23-61)years,and 10 non-splenomegaly patients including 5 males and 5 females with a median age of 39(12-56)years.Clinical characteristics at baseline were comparable in two groups(P>0.05).The neutrophil engraftment rates in splenomegaly and non-splenomegaly patients were 93.3%(14/15)and 100.0%(10/10),and with a median time of 17(11-20)days and 14(11-18)days respectively(χ^2=5.303,P=0.021).The platelet engraftment rates in splenomegaly and no-splenomegaly patients were 80.0%(12/15)and 90.0%(9/10)(P=0.212),and the median time of engraftment was 17(12-33)days and 15(12-19)days respectively(χ^2=0.470,P=0.493).Five patients with splenomegaly developed acute GVHD(aGVHD)(4 patients with gradeⅠ/Ⅱ,1 with gradeⅢ/Ⅳ),and 6 patients developed aGVHD in non-splenomegaly group(5 with gradeⅠ/Ⅱ,1 with gradeⅢ/Ⅳ)(χ^2=0.204,P=0.652).The cumulative incidences of aGVHD at 100 days between two groups were 33.3%(95%CI 14.9%-51.7%)and 20.0%(95%CI 2.8%-37.2%)respectively(P=0.635).Five patients in splenomegaly group developed chronic GVHD(cGVHD)including 3 patients with extensive cGVHD.None in non-splenomegaly group reported cGVHD(P=0.041).The 3-year cumulative incidences of relapse in splenomegaly and non-splenomegaly patients were(42.7±2.6)%and(11.1±1.2)%(P=0.122),and the 3-year overall survival rates were(61.5±13.5)%and(68.6±15.1)%(χ^2=0.351,P=0.554).In addition,the leukemia-free survival rates were(56.3±14.8)%and(80.0±

关 键 词：慢性粒单核细胞白血病 异基因造血干细胞移植 脾肿大 

分 类 号：R733[医药卫生—肿瘤]