恶性血液病患者单倍体相合外周血干细胞移植后血清免疫球蛋白水平的临床意义分析  

Clinical Significance of Serum Immunoglobulin Level after Peripheral Blood Haploidentical Hematopoietic Stem Cell Transplantation in Patients with Hematologic Malignancies

作　　者：林涛 方姝 王飞雁 谷振阳 高晓宁 李菲 李猛 黄文荣 刘代红 高春记 LIN Tao;FANG Shu;WANG Fei-Yan;GU Zhen-Yang;GAO Xiao-Ning;LI Fei;LI Meng;HUANG Wen-Rong;LIU Dai-Hong;GAO Chun-Ji(Department of Hematology,Medical College of Chinese PLA,First center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,中国人民解放军总医院第一医学中心血液科,北京100853

出　　处：《中国实验血液学杂志》2020年第5期1774-1781,共8页Journal of Experimental Hematology

基　　金：北京市自然科学基金(7162175)。

摘　　要：目的:探讨恶性血液病患者单倍体相合外周血干细胞移植后免疫球蛋白水平的临床意义。方法:回顾性分析157例行单倍体外周血干细胞移植患者的总生存(OS)率、移植物抗宿主病(GVHD)发生率、感染发生率、血清免疫球蛋白水平与OS及主要移植并发症的关系。结果:所有患者2年OS率为59.2%(95%CI:51.6%-66.9%),2年复发死亡率为11.5%(95%CI:6.4%-16.6%),非复发死亡率(NRM)为29.3%(95%CI:21.7%-36.9%)。Ⅲ-Ⅳ度aGVHD累积发生率为16.6%(95%CI:10.8%-22.9%);广泛性cGVHD累积发生率为21.7%(95%CI:15.3%-28.6%);1年内严重细菌感染累积发生率为59.2%(95%CI:51.6%-66.2%);侵袭性真菌感染累积发生率为47.1%(95%CI:38.9%-54.8%)。单倍体外周血干细胞移植后广泛性cGVHD的发生与供受体性别是否相合、移植后细菌感染有关。发生0-Ⅱ度aGVHD与发生Ⅲ-Ⅳ度急性GVHD组患者移植后1个月免疫球蛋白IgG水平分别为(6.96±2.47)和(4.27±2.42)g/L(P=0.003)、3个月免疫球蛋白IgG水平分别为(8.71±4.47)和(6.65±2.95)g/L(P=0.038);移植后1个月IgG水平在一定程度上可预测Ⅲ-Ⅳ度aGVHD的易感性(P=0.003);移植后任意时间IgG<4 g/L的患者中,广泛性cGVHD发生率显著升高(35.5%vs 18.3%,P=0.037),1年内的真菌感染发生率显著升高(71.0%vs 41.3%,P=0.003),2年生存率显著下降(P=0.035)。结论:单倍体外周血干细胞移植是治疗恶性血液病的有效手段;移植后1个月免疫球蛋白IgG减少的患者更易发生Ⅲ-Ⅳ度急性GVHD,并且IgG水平在一定程度上可预测其易感性。单倍体外周血干细胞移植后重度免疫球蛋白减少(IgG<4 g/L)的患者更易发生广泛性cGVHD及真菌感染,并且与移植后的生存预后显著相关。Objective:To investigate the clinical significance of post-transplantation serum immunoglobulin level in the outcome of patients with hemalologic malignancies treated by haploidentical peripheral hematopoietic stem cell transplanta-tion(Haplo-HSCT).Methods:The clinical data of 157 patients treated by haplo-HSCT were analyzed retrospectively.The overall survival rate(OS),graft versus host disease(GVHD)incidence,infection incidence,serum immunoglobulin level,the relationship of immunoglobulin levels with OS and transplant complications were analyzed.Results:The 2-year OS rate was 59.2%(95%CI:51.6%-66.9%),2-year relapse mortality was 11.5%(95%CI:6.4%-16.6%),and non-relapse mortality was 29.3%(95%CI:21.7%-36.9%).The cumulative incidence ofⅢ-ⅣaGVHD was 16.6%(95%CI:10.8%-22.9%);the cumulative incidence of extensive cGVHD was 21.7%(95%CI:15.3%-28.6%);the cumulative incidence of severe bacterial infection within 1 year was 59.2%(95%CI:51.6%-66.2%);the cumulative incidence of invasive fungal infection was 47.1%(95%CI:38.9%-54.8%).The occurrence of extensive cGVHD after haplo-HSCT related with the gender match of donor-recipient and bacterial infection.The levels of IgG in patients with 0-ⅡaGVHD and patients withⅢ-ⅣaGVHD for 1 month after haplo-HSCT were(6.96±2.47)and(4.27±2.42)g/L(P=0.003),IgG levels at 3 months afte haplo-HSCT were(8.71±4.47)and(6.65±2.95)g/L(P=0.038);IgG levels at 1 month after haplo-HSCT showed predictive value forⅢ-ⅣaGVHD susceptibility(P=0.003);for patients with IgG<4 g/L at any time after haplo-HSCT,the incidence of extensive cGVHD was significantly increased(35.5%vs 18.3%)(P=0.037),the incidence of fungal infection within 1 year after haplo-HSCT was significantly increased(71.0%vs 41.3%)(P=0.003),and the 2-year survival rate was reduced significantly(P=0.035).Conclusion:Haplo-HSCT is effective for the treatment of hematologic malignancies.Patients with lower IgG at 1 month after haplo-HSCT are more likely to developⅢ-ⅣaGVHD,and IgG levels at 1 month after haplo-HSCT can predic

关 键 词：血清免疫球蛋白 单倍体外周血干细胞移植 移植物抗宿主病 感染 

分 类 号：R733[医药卫生—肿瘤] R394.2[医药卫生—临床医学]