髓系肿瘤患者异基因造血干细胞移植后原发性植入功能不良的危险因素分析  

Risk Factors of Primary Poor Graft Function after Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Myeloid Malignancies

作　　者：张琳依 熊艺颖[1] 廖明燕[1] 肖青[1] 唐晓琼[1] 罗小华[1] 张红宾[1] 王利[1] 刘林[1] ZHANG Lin-Yi;XIONG Yi-Ying;LIAO Ming-Yan;XIAO Qing;TANG Xiao-Qiong;LUO Xiao-Hua;ZHANG Hong-Bin;WANG Li;LIU Lin(Department of Hematology,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院血液内科,重庆400016

出　　处：《中国实验血液学杂志》2024年第6期1875-1881,共7页Journal of Experimental Hematology

基　　金：重庆医科大学附属第一医院学科创新基金学科培育项目(03010203XKTS192)。

摘　　要：目的:分析髓系肿瘤患者异基因造血干细胞移植(allo-HSCT)后发生原发性植入功能不良(PGF)的危险因素及原发性PGF对生存的影响。方法:对2015年1月-2021年12月在本院行allo-HSCT的146例髓系肿瘤患者的临床资料进行回顾性分析,选择可能影响allo-HSCT后发生原发性PGF的相关临床参数进行单因素和多因素分析,同时进行生存分析。结果:共9例(6.16%)患者发生原发性PGF,中位年龄为37(28-53)岁;其中,同胞全相合移植1例,无关供者移植1例,单倍体移植7例;合并CMV感染5例,合并EBV感染3例。单因素及多因素分析显示,CD34+<5×10^(6)/kg和移植前CRP>10 mg/L是髓系肿瘤患者allo-HSCT后发生原发性PGF的独立危险因素。原发性PGF组的3年总生存率为52.5%,显著低于植入功能良好组的82.8%(P<0.05)。结论:移植前确保CRP≤10 mg/L、移植造血干细胞中CD34+≥5×10^(6)/kg可能是预防allo-HSCT后原发性PGF发生的有效措施。原发性PGF的发生可能会影响移植患者的总生存率,需早期做好防治工作。Objective:To analyze the risk factors of primary poor graft function(PGF)after allogeneic hematopoietic stem cell transplantation(allo-HSCT)in patients with myeloid malignancies and the impact of primary PGF on survival.Methods:The clinical data of 146 patients with myeloid malignancies who underwent allo-HSCT in our hospital from January 2015 to December 2021 were retrospectively studied.Some relevant clinical parameters which may affect the development of primary PGF after allo-HSCT were selected for univariate and multivariate analysis,as well as performed survival analysis.Results:A total of 9 patients(6.16%)were diagnosed with primary PGF,and their medium age was 37(28-53)years old.Among them,1 case underwent matched sibling donor HSCT,1 case underwent matched unrelated donor HSCT,and 7 cases underwent HLA-haploidentical related donor HSCT.Moreover,5 cases were diagnosed as cytomegalovirus(CMV)infection,and 3 cases as Epstein-Barr virus(EBV)infection.Univariate and multivariate analysis showed that+CD34 cell dose<5×10^(6)/kg and pre-transplant C-reactive protein(CRP)>10 mg/L were independent risk factors for occurrence of the primary PGF after allo-HSCT in patients with myeloid malignancies.The 3-year overall survival(OS)rate of primary PGF group was 52.5%,which was significantly lower than 82.8%of good graft function group(P<0.05).Conclusion:Making sure pre-transplant CRP≤10 mg/L and+CD34 cell dose≥5×10^(6)/kg in the graft may have an effect on preventing the occurrence of primary PGF after allo-HSCT.The occurrence of primary PGF may affect the OS rate of transplant patients,and early prevention and treatment are required.

关 键 词：原发性植入功能不良 异基因造血干细胞移植 危险因素 髓系肿瘤 

分 类 号：R457.7[医药卫生—治疗学]