异基因造血干细胞移植治疗骨髓增生异常综合征49例临床分析

於芳芳; 杨隽; 姜杰玲; 蔡宇; 李肃; 许晓巍; 赵初娴; 蒋瑛; 王椿; 宋献民; 万理萍

doi:10.13201/j.issn.1004-2806.2020.01.010

异基因造血干细胞移植治疗骨髓增生异常综合征49例临床分析

- 上海交通大学附属第一人民医院血液科(上海, 200080)
基金项目:
上海市科委专项经费(No:17411968300)

详细信息

通讯作者: 万理萍,E-mail:lipingwan@sjtu.edu.cn

中图分类号: R733

收稿日期: 2019-06-30

Clinical analysis of 49 patients with myelodysplastic syndrome treated by allogeneic stem cell transplantation

- Department of Hematology, Shanghai Jiao Tong University Affiliated Shanghai General Hospital, Shanghai, 200080, China

More Information

Corresponding author: WAN Liping, E-mail: lipingwan@sjtu.edu.cn

Received Date: 30 June 2019

摘要

摘要: 目的:分析异基因造血干细胞移植(allo-HSCT)治疗骨髓增生异常综合征(MDS)的疗效及影响生存的相关因素。方法:对49例行allo-HSCT的MDS患者进行回顾性研究,应用Kaplan-Meier曲线和Log-rank检验分析总生存,并对影响患者预后的相关因素进行单因素和COX比例风险回归分析。结果:49例患者中年龄≥60岁10例,单倍体移植26例,中位随访13.7(0.4~65.4)个月,中性粒细胞植入中位时间13(7~25) d,血小板植入中位时间12(6~48) d,达到完全供者嵌合的中位时间为移植后15(9~51) d。Ⅱ~Ⅳ度急性移植物抗宿主病(aGVHD)及慢性移植物抗宿主病发生率分别为14.3%、27.9%,复发率为14.3%,年龄＜60岁与年龄≥60岁患者的1年总生存率分别为77.0%、40.0%。年龄＜60岁患者中,单倍体移植与全相合移植的1年总生存率分别为76.0%、78.0%。COX比例风险回归分析结果显示,年龄≥60岁的MDS患者生存率较60岁以下患者低(HR=3.5,95%CI 1.08~11.32,P=0.04),而移植前病程、移植时骨髓原始细胞比例、供者类型及Ⅱ~Ⅳ度aGVHD等对MDS患者总体生存无明显影响。结论:对于年龄＜60岁MDS患者,allo-HSCT是有效的治疗方法。无HLA相合供者的患者,单倍体移植疗效与HLA全相合移植结果相似。对于年龄60~70岁的老年患者,如果体能状态和主要脏器功能良好,allo-HSCT亦可能是较好的治疗选择。
- 骨髓增生异常综合征 /
- 异基因造血干细胞移植 /
- 生存影响因素
Abstract: Objective:To analyze the efficacy of allogeneic hematopoietic stem cell transplantation(allo-HSCT) in the treatment of myelodysplastic syndrome(MDS) and survival related risk factors.Method:A retrospective study was performed on 49 patients with MDS who underwent allo-HSCT.The Kaplan-Meier curve and Log-rank test were used to analyze the overall survival,and prognostic factors were analyzed with COX proportional hazard regression.Result:Among the 49 patients underwent allo-HSCT,10 patients were aged ≥60 years and 26 patients were transplanted from haploidentical donors.The median follow-up time was 13.7(0.4-65.4) months.The median time of granulocyte and platelet engraftment was 13(7-25) days and 12(6-48) days.The median time to complete donor chimerism was 15(9-51) days after transplantation.The incidence of gradeⅡ-Ⅳ acute graft versus host disease(aGVHD) and chronic GVHD was 14.3% and 27.9%,respectively.The relapse rate was 14.3%.The 1-year overall survival rate in patients aged ＜60 years and ≥60 years was 77.0% and 40.0%,respectively.In patient aged ＜60 years,the 1-year overall survival rate of patients transplanted from haploidentical donors and matched donors were 76.0% and 78.0%,respectively.COX proportional hazard regression analysis showed that patients aged ≥60 years had a lower survival rate than patients aged ＜60 years(HR=3.5,95%CI 1.08-11.32,P=0.04).However,the period from diagnosis to transplantation,the percentage of blasts in bone marrow,donor types and Ⅱ-Ⅳ grade aGVHD had no significant effect on overall survival.Conclusion:allo-HSCT is an effective treatment for patients with MDS aged＜60 years.For patients without HLA-matched donors,haploidentical HSCT could achieve similar results to that of HLA-matched HSCT.For patients aged between 60-70 years old,allo-HSCT may be a feasible option if they are in good condition and without major organ comorbidities.
- myelodysplastic syndrome /
- allogeneic hematopoietic stem cell transplantation /
- survival analysis

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