恶性血液病患者半相合造血干细胞移植后辅助性T细胞重建对临床预后的影响  

The impact of helper T cell reconstitution on clinical outcomes after HLA-haploidentical allogeneic hematopoietic stem cell transplantation in patients with hematologic malignancy

作　　者：李淼静 李志一 赵娟[1] 赵思捷 罗敏娜 王洁 贺鹏程[1] 吴迪 LI Miaojing;LI Zhiyi;ZHAO Juan;ZHAO Sijie;LUO Minna;WANG Jie;HE Pengcheng;WU Di(Department of Hematology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an,710061,China)

机构地区：[1]西安交通大学第一附属医院血液内科,西安710061

出　　处：《临床血液学杂志》2024年第11期803-807,共5页Journal of Clinical Hematology

基　　金：陕西省重点研发计划项目(No:2020SF-176,2022SF-239)。

摘　　要：目的:探讨恶性血液病患者半相合造血干细胞移植后辅助性T细胞重建对临床预后的影响。方法:纳入2020年7月-2022年12月于西安交通大学第一附属医院血液内科接受半相合造血干细胞移植的恶性血液病患者46例,通过流式细胞术检测移植后外周血T细胞亚群,以供者作为健康对照,分析移植后T细胞重建的规律。通过ROC曲线、Kaplan-Meier生存分析、χ^(2)检验等分析辅助性T细胞重建对移植后患者总生存期(OS)和急性移植物抗宿主病(aGVHD)的影响。结果:移植后辅助性T细胞恢复较慢,移植后12个月仍显著低于对照组,但呈上升趋势。移植后3个月辅助性T细胞计数<70/μL组及移植后9个月辅助性T细胞计数<95/μL组OS更差。移植后3个月辅助性T细胞计数<90/μL组aGVHD的发生率更高。结论:恶性血液病患者半相合造血干细胞移植后辅助性T细胞恢复较慢,移植后辅助性T细胞重建不良预示更差的OS和更高的aGVHD发生率。可通过动态监测辅助性T细胞重建情况筛选潜在预后不良患者。Objective To explore the impact of helper T cell reconstitution on clinical outcomes in patients with hematologic malignancies after HLA-haploidentical allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods Forty-six patients who received HLA-haploidentical allo-HSCT in the Department of Hematology of the First Affiliated Hospital of Xi'an Jiaotong University from July 2020 to December 2022 were analyzed.T lymphocyte subsets were detected by flow cytometry at different time after transplantation.The clinical data of healthy donors were used as controls to analyze the regularity of T cell reconstitution after transplantation.ROC curves,Kaplan-Meier survival analysis and Chi-square tests were used to analyze the effects of helper T cell reconstitution on overall survival(OS)and acute graft versus host disease(aGVHD).Results Helper T cell recovered slowly after transplantation which were significantly lower than those of healthy controls at 12 months after transplantation,but showed an increasing trend.Helper T cell count<70/μL after 3 months of transplantation and<95/μL at 9 months after transplantation predicted poor OS.Helper T cell count<90/μL at 3 months after transplantation predicted a high incidence of aGVHD.Conclusion The reconstruction of helper T cell after allo-HSCT was slow.Poor reconstruction of helper T cell after transplantation predicted worse OS and a higher incidence of aGVHD.Patients with potentially poor prognosis could be screened by monitoring of helper T cell reconstruction.

关 键 词：辅助性T细胞 半相合造血干细胞移植 临床预后 急性移植物抗宿主病 

分 类 号：R457.7[医药卫生—治疗学]