供患者性别组合对恶性血液病患者单倍体造血干细胞移植结局的影响  

The impact of donor-to-recipient gender compatibility on outcomes of haploid hematopoietic stem cell transplantation in patients with hematological malignancies

作　　者：胡姗姗 吴一波[1,2] 朱盼盼 施继敏 余建[1,2] 赵妍敏[1,2] 来晓瑜[1,2] 刘丽珍[1,2] 傅华睿[1,2] 黄河[1,2] 罗依[1,2] Hu Shanshan;Wu Yibo;Zhu Panpan;Shi Jimin;Yu Jian;Zhao Yanmin;Lai Xiaoyu;Liu lizhen;Fu Huarui;Huang He;Luo Yi(Bone Marrow Transplantation Center,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China;Institute of Hematology,Zhejiang University,Hangzhou 310000,China;Department of Hematology,Jinhua People's Hospital,Jinhua 321000,China)

机构地区：[1]浙江大学医学院附属第一医院骨髓移植中心,杭州310000 [2]浙江大学血液学研究所,杭州310000 [3]金华市人民医院血液科,金华321000

出　　处：《中华血液学杂志》2022年第12期992-1002,共11页Chinese Journal of Hematology

基　　金：国家重点研发计划(2018YFA0107804);国家自然科学基金面上项目(81970158、82170205);浙江省金华市科学技术局公益类项目(2021-4-075)。

摘　　要：目的探究供患者性别组合对基于抗胸腺细胞球蛋白(ATG)和单纯外周血干细胞(PBSC)来源单倍体造血干细胞移植(haplo-HSCT)治疗恶性血液病移植结局的影响。方法对2015年2月至2020年9月在浙江大学医学院附属第一医院骨髓移植中心接受清髓性haplo-HSCT的648例恶性血液病患者进行回顾性分析。男363例(56.0%),女285例(44.0%),中位年龄32(14~62)岁。急性淋巴细胞白血病(ALL)242例(37.3%),急性髓系白血病(AML)293例(45.2%),骨髓增生异常综合征(MDS)56例(8.7%),非霍奇金淋巴瘤(NHL)27例(4.2%),其他恶性血液病30例(4.6%)。结果①所有患者移植后3年总生存(OS)率为(73.10±1.90)%,无病生存(DFS)率为(70.80±1.90)%,Ⅱ~Ⅳ度、Ⅲ/Ⅳ度急性移植物抗宿主病(GVHD)累积发生率分别为(33.96±1.87)%、(13.08±1.33)%,3年中/重度慢性GVHD、重度慢性GVHD累积发生率分别为(35.10±2.14)%、(10.66±1.38)%,累积复发率(CIR)为(19.43±1.67)%,非复发死亡率(NRM)为(9.80±1.24)%。②供患者性别相合、性别不合组haplo-HSCT后28 d累积中性粒细胞植入率、血小板植入率差异无统计学意义(P=0.270,P=0.842),Ⅱ~Ⅳ度、Ⅲ/Ⅳ度急性GVHD累积发生率及移植后3年OS率、DFS率、CIR、NRM率、慢性GVHD累积发生率差异均无统计学意义(P>0.05)。③男供女、女供女、男供男、女供男组haplo-HSCT后28 d累积中性粒细胞植入率差异无统计学意义(P=0.148),Ⅱ~Ⅳ度、Ⅲ/Ⅳ度急性GVHD累积发生率及移植后3年OS率、DFS率、CIR、NRM、慢性GVHD累积发生率差异均无统计学意义(P>0.05)。女供男组移植后28 d累积血小板植入率[(91.45±2.63)%]低于男供女组[(94.77±1.75)%,P=0.004]、女供女组[(95.54±2.05)%,P=0.005],与男供男组[(95.08±1.41)%,P=0.284]比较差异无统计学意义。④在≤35岁患者中,姐妹供者组、兄弟供者组移植后3年重度慢性GVHD累积发生率分别为(26.71±5.90)%、(10.33±4.43)%(P=0.054);在>35岁患者中,女儿供者组、儿子供�Objective To investigate how gender differences between the donor and the recipient affect the effectiveness of antithymocyte globulin(ATG)and pure peripheral blood stem cell(PBSC)hematopoietic stem cell transplantation(haplo-HSCT)in the treatment of malignant hematological diseases.Methods From February 2015 to September 2020,648 hematological malignancies patients underwent myeloablative condition regimen haplo-HSCT treatment at the Bone Marrow Transplant Center of the First Affiliated Hospital of Zhejiang University.The median age was 32(14-62)years,with 363 males(56.0%)and 285 females(44.0%)present.242 cases of acute lymphoblastic leukemia(ALL)(37.3%),293 cases of acute myeloid leukemia(AML)(45.2%),56 cases of myelodysplastic syndrome(MDS)(8.7%),27 cases of non-Hodgkin's lymphoma(NHL)(4.2%),and 30 cases of other hematological malignancies(4.6%).Results①The 3-year overall survival(OS),DFS,the incidence ofⅡ-Ⅳgrade acute graft-versus-host disease(aGVHD),the incidence ofⅢ-Ⅳgrade aGVHD,the 3-year incidence of moderate&severe chronic GVHD(cGVHD),severe cGVHD,the 3-year incidence of relapse,and NRM of the whole group were(73.10±1.90)%,(70.80±1.90)%,(33.96±1.87)%,(13.08±1.33)%,(35.10±2.14)%,(10.66±1.38)%,(19.43±1.67)%,and(9.80±1.24)%,respectively.②There was no statistically significant difference between the donor-recipient gender match and donor-recipient gender mismatch groups in the 28-day cumulative neutrophil engraftment rate,28-day cumulative platelet engraftment rate,the incidence ofⅡ-Ⅳgrade aGVHD,the incidence ofⅢ-Ⅳgrade aGVHD,3-year OS,3-year DFS,the cumulative incidence of relapse,NRM,and incidence of moderate&severe cGVHD,severe cGVHD.③The 28-day cumulative neutrophil engraftment rate did not differ statistically between the male-female,female-female,male-male,and female-male groups(P=0.148).The incidence ofⅡ-Ⅳgrade aGVHD,the incidence ofⅢ-Ⅳgrade aGVHD,3-year OS,3-year DFS,cumulative relapse rate,and NRM,and the incidence of cGVHD were not statistically different among

关 键 词：单倍体造血干细胞移植 临床结局 供者选择 

分 类 号：R733[医药卫生—肿瘤]