单倍体相同供者和HLA相合同胞供者HSCT治疗SAA的疗效和安全性比较  

Comparison ofhaploidentical donor versus HLA-matched sibling donor hematopoietic stem cell transplantation for severe aplastic anemia

作　　者：吴佳颖 罗文芳 肖毅[1] 曹阳[1] 黄丽芳 王娜 徐金环[1] 王珏[1] 孟凡凯[1] 张东华[1] 张义成[1] Wu Jiaying;Luo Wenfang;Xiao Yi;Cao Yang;Huang Lifang;Wang Na;Xu jinhuan;Wang Jue;Meng Fankai;Zhang Donghua;Zhang Yicheng(Department of Hematology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院血液内科,武汉430030

出　　处：《中华器官移植杂志》2021年第12期738-743,共6页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金面上项目(81570110)。

摘　　要：目的比较单倍体相同供者(HID)和人类白细胞抗原(HLA)相合同胞供者(MSD)造血干细胞移植(HSCT)治疗重型再生障碍性贫血(SAA)的临床疗效及安全性。方法回顾性收集2012年1月1日至2019年12月31日华中科技大学同济医学院附属同济医院血液内科接受HSCT的75例SAA受者的临床资料,根据供者来源不同分为HLA相合的同胞供者组(MSD组,49例)和单倍体相同的供者组(HID组,26例),比较两组的造血重建、移植物抗宿主病(GVHD)、感染情况和总存活率。结果MSD组和HID组受者血小板中位植入时间均为11 d(P=0.84),中性粒细胞中位植入时间分别为11 d和12 d(P=0.08),急性GVHD的发生率分别为18.4%和46.2%(P=0.01),其中Ⅱ~Ⅳ度分别为14.3%和26.9%(P=0.24),Ⅲ~Ⅳ度分别为4.1%和15.4%(P=0.09),慢性GVHD的发生率分别为23.1%和23.9%(P=0.71);巨细胞病毒血症发生率分别为55.1%和84.6%(P=0.01),EB病毒血症发生率分别为69.4%和61.5%(P=0.49)。中位随访54.0个月和18.5个月,MSD组和HID组的预估3年总存活率分别为94.0%和88.0%(P=0.35)。结论HID HSCT治疗SAA相对安全、有效,可作为缺乏MSD但急需治疗的首诊或免疫抑制治疗无效/复发者的选择之一。Objective To compare the clinical outcomes and safety of haploidentical donor(HID)and HLA-matched sibling donor(MSD)hematopoietic stem cell transplantation(HSCT)for severe aplastic anemia(SAA).Methods From January 1,2012 to December 31,2019,retrospective review of clinical data was performed for 75 SAA patients undergoing HSCT at Department of Hematology,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology.Based upon donor sources,they were divided into two groups of MSD(49 cases)and HID(26 cases).And two groups were compared with regards to hematopoietic recovery,graft-versus-host disease(GVHD)infection and overall survival(OS).Results Time of platelet and neutrophil engraftment of two groups was comparable(11 d vs.11 d,P=0.84;11 d vs.12 d,P=0.08).Compared with HID group,MSD group had a lower incidence of acute GVHD(46.2%vs.18.4%,P=0.01)with a comparable incidence of gradeⅡ-Ⅳacute GVHD(26.9%vs.14.3%,P=0.24),gradeⅢ-Ⅳacute GVHD(15.4%vs.4.1%,P=0.09)and chronic GVHD(23.9%vs.23.1%,P=0.71).A reactivation of CMV occurred in 27(55.1%)MSD and 22(84.6%)HID recipients(P=0.01).And the incidence of EB viremia was 69.4%and 61.5%respectively.After a median follow-up period of 54.0 and 18.5 months,the estimated 3-year OS rate of MSD and HID groups were 94.0%and 88.0%respectively(P=0.35).Conclusions HID HSCT is an effective and relatively safe option for SAA patients,especially for those in urgent need of treatment without MSD or refractory/relapse to immunosuppressive therapy.

关 键 词：造血干细胞移植 重型再生障碍性贫血 单倍体相同的供者 

分 类 号：R556.5[医药卫生—血液循环系统疾病]