Effect of haploidentical and matched sibling donor allogeneic hematopoietic stem cell transplantation on hematologic malignancies
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摘要: 目的 探讨单倍体与同胞相合异基因造血干细胞移植治疗恶性血液病疗效及影响预后的相关因素。方法 分析2013年6月—2019年12月于山西白求恩医院行异基因造血干细胞移植的82例恶性血液病患者的临床资料，急性髓系白血病51例，骨髓增生异常综合征11例，急性淋巴细胞白血病20例。同胞全相合异基因造血干细胞移植(MSD-HSCT)30例，单倍体异基因造血干细胞移植(Haplo-HSCT)52例。结果 82例患者中位随访时间为15个月，总植入率为87.8%，移植前疾病未缓解者MSD-HSCT组占26.7%(8/30)，Haplo-HSCT组占15.4%(8/52)，Haplo-HSCT组和MSD-HSCT组移植后2年总生存率(OS)分别为63.3 %和65.4%，差异无统计学意义(P=0.771)，其中Haplo-HSCT组患者Ⅰ~Ⅱ度急性移植物抗宿主病(aGVHD)发生率为73.1%(38/52)，明显高于MSD-HSCT组的46.7%(14/30)，差异有统计学意义(P=0.017)，其余移植相关并发症包括植入失败率、Ⅲ~Ⅳ度aGVHD、外周血巨细胞病毒、EB病毒、出血性膀胱炎, 2组比较均差异无统计学(P＞0.05)。多因素分析结果显示，Ⅲ~Ⅳ度aGVHD和移植前缓解状态是影响患者生存率的危险因素，相对风险分别为5.944、4.995(P＜0.05)。结论 恶性血液病患者接受Haplo-HSCT与MSD-HSCT疗效相近，移植前缓解状态和移植后重度aGVHD对患者长期生存具有重要意义。
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关键词:
- 恶性血液病 /
- 单倍体 /
- 同胞相合 /
- 异基因造血干细胞移植 /
- 疗效
Abstract: Objective To investigate the curative effect and prognostic factors of haploid and sibling allogeneic hematopoietic stem cell transplantation for malignant hematologic diseases.Methods The clinical data of 82 patients with malignant hematologic diseases who received allogeneic hematopoietic stem cell transplantation in our hospital from June 2013 to December 2019 were analyzed, including 51 cases of acute myeloid leukemia, 11 cases of myelodysplastic syndrome, and 20 cases of acute lymphoblastic leukemia. There were 30 cases of MSD-HSCT and 52 cases of Haplo-HSCT.Results The median follow-up time of 82 patients was 15 months. The total implantation rate was 87.8%. Before transplantation, 26.7%(8/30) of patients in the MSD-HSCT group and 15.4%(8/52) of patients in the Haplo-HSCT group had non-remission. 2-year overall survival(OS) after transplantation was 63.3% in Haplo-HSCT group and 65.4% in MSD-HSCT group(P=0.771). The incidence of grade Ⅰ-Ⅱ aGVHD in Haplo-HSCT group was 73.1%(38/52), which was significantly higher than 46.7%(14/30) in MSD-HSCT group(P=0.017). There were no significant differences in other transplant-related complications, including implantation failure rate, grade Ⅲ-Ⅳ aGVHD, EBV, CMV viremia and hemorrhagic cystitis between the two groups(P > 0.05). Multivariate analysis showed that grade Ⅲ-Ⅳ aGVHD and remission status before transplantation were risk factors affecting the survival of patients. The relative risks were respectively 5.944, 4.995(P < 0.05).Conclusion The efficacy of Haplo-HSCT was similar to that of MSD-HSCT in patients with hematologic malignancies. The grade Ⅲ-Ⅳ aGVHD and pre-transplant remission status were risk factors affecting the survival of patients. -
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表 1 2组患者基本情况比较
类别 MSD-HSCT组(n=30) Haplo-HSCT组(n=52) χ2/t P 男∶女/例 17∶13 29∶23 0.006 0.937 年龄/岁 36.9±13.0 34.2±12.0 -0.981 0.330 供受者性别相同/例(%) 14(46.7) 35(67.3) 3.730 0.066 疾病类型/例 2.227 0.328 AML 16 35 ALL 8 12 MDS 6 5 移植前疾病状态/例 2.220 0.136 CR 22 44 未缓解 8 8 
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表 2 2组患者并发症比较
例(%) 组别 植入失败 Ⅰ~Ⅱ度aGVHD Ⅲ~Ⅳ度aGVHD EBV CMV HC 总生存 MSD-HSCT组(n=30) 3(10.0) 14(46.7) 4(13.3) 8(26.7) 5(16.7) 6(20.0) 20(66.7) Haplo-HSCT组(n=52) 7(13.5) 38(73.1) 10(19.2) 24(46.2) 13(25.0) 21(40.4) 36(69.2) χ2 0.012 5.720 0.467 3.036 0.771 3.579 0.058 P 0.912 0.017 0.494 0.081 0.380 0.058 0.810
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表 3 影响恶性血液病患者预后单因素、多因素分析
项目 分类 单因素分析 多因素分析 χ2 P RR(95%CI) P 性别 男 0.210 0.647 女 AML 诊断 ALL 0.469 0.791 MDS 移植前缓解状态 CR 11.759 0.001 4.995(2.145~11.63) ＜0.001 未缓解 移植类型 MSD-HSCT 0.085 0.771 Haplo-HSCT Ⅰ~Ⅱ度aGVHD 无 2.681 0.102 有 Ⅲ~Ⅳ度aGVHD 无 19.764 ＜0.001 5.944(2.545~13.881) ＜0.001 有 HC 无 2.623 0.105 有 CMV 无 0.315 0.574 有 EBV 无 1.353 0.245 有 供受者性别是否相同 相同 0.007 0.931 不同 植入失败 无 3.938 0.047 1.850(0.67~5.107) 0.235 有
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