Clinical observation of anti-thymocyte globulin/anti-lymphocyte globulin in allogeneic stem cell transplantation
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摘要: 目的 比较抗人胸腺淋巴细胞球蛋白(anti-thymocyte globulin，ATG)/抗淋巴细胞免疫球蛋白(anti-lymphocyte globulin，ALG)在异基因干细胞移植应用中的临床疗效及不良反应。方法 回顾性分析2015年1月至2021年4月我院36例接受异基因干细胞移植的恶性血液病患者的临床资料，包括基础疾病、年龄、性别、供者类别、HLA配型相合度及回输的单个核细胞计数、CD34细胞计数、预处理方案等。按照预处理方案选择ATG或ALG将患者进行分组，ATG组11例，ALG组25例。观察2组患者中性粒细胞及血小板植入情况，急性及慢性移植物抗宿主病发生情况、患者生存情况及移植后病毒感染率。结果 中位随访时间26.4(2.0~71.3)个月，ATG组和ALG组患者中位生存期分别为32.9(9.0~41.0)个月和38.0(5.0~71.3)个月，差异无统计学意义(P=0.44)。截至随访结束，ALG组和ATG组患者中性粒细胞植入的中位时间分别为13.4 d和13.3 d，差异无统计学意义(P=0.30)。ATG组和ALG组患者死亡率分别为27.3%和36.0%，差异无统计学意义(P=0.47)。ALG组和ATG组移植后病毒感染率分别为12.0%和18.2%，差异无统计学意义(P=0.63)。ALG组和ATG组急性移植物抗宿主病发生率分别为44.0%和45.5%，差异无统计学意义(P=1.00)；慢性移植物抗宿主病发生率分别为44.0%和18.2%，差异亦无统计学意义(P=0.26)。结论 ALG在异基因干细胞移植的疗效与ATG相当，虽然ALG组慢性移植物抗宿病发生率高于ATG组，但差异无统计学意义。
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关键词:
- 抗人胸腺淋巴细胞球蛋白/抗淋巴细胞免疫球蛋白 /
- 异基因造血干细胞移植 /
- 急性移植物抗宿主病 /
- 慢性移植物抗宿主病 /
- 恶性血液病
Abstract: Objective To observe the clinical efficacy and adverse events of anti-thymocyte globulin(ATG)/anti-lymphocyte globulin(ALG) in allogeneic stem cell transplantation.Methods The clinical data of 36 patients with hematologic malignancies who received allogeneic stem cell transplantation in our hospital from January 2015 to April 2021 were retrospectively analyzed. The clinical data of patients included age, basic disease, sex, donor type, match degree, mononuclear cell counts, CD34 counts and preparative regimen. According to the pretreatment scheme, patients were divided into ATG group and ALG group, with 11 cases in the ATG group and 25 cases in the ALG group. The implantation of granulocytes and platelets, the occurrence of acute and chronic graft versus host disease(GVHD), the survival of patients and the virus infection after transplantation in the two groups were observed.Results The median follow-up time was 26.4(range 2.0 to 71.3) months. The median survival time of ATG group and ALG group was 32.9(range 9.0 to 41.0) months and 38.0(range 5.0 to 71.3) months, respectively, and there was no significant difference(P=0.44). By the end of follow-up, the duration of neutrophils implantation in ALG group and ATG group was 13.4 days and 13.3 days, respectively, and there was no significant difference(P=0.30). The mortality in ATG group and ALG group was 27.3% and 36.0%, respectively, and there was no significant difference(P=0.47). The virus infection rates of ALG group and ATG group were 12.0% and 18.2%, respectively, and there was no significant difference(P=0.63). The rates of acute GVHD in ALG group and ATG group were 44.0% and 45.5%, respectively, and there was no significant difference(P=1.00). The rates of chronic GVHD in ALG group and ATG group were 44.0% and 18.2%, respectively, and there was no significant difference(P=0.26).Conclusion The efficacy of ALG in allogeneic stem cell transplantation is similar to that of ATG. However, the incidence of chronic GVHD in ALG group is higher than that of ATG group, but there is no significant difference. -
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表 1 ATG组和ALG组基本资料比较
ALG组(25例) ATG组(11例) 统计值 P 性别/例(%) χ2=1.178 0.471 男 14(56.0) 4(36.4) 女 11(44.0) 7(63.6) 疾病类型/例(%) χ2=1.100 0.820 再生障碍性贫血 14(56.0) 5(45.5) 急性淋巴细胞白血病 4(16.0) 2(18.2) 急性髓系白血病 5(20.0) 3(27.3) 骨髓增生异常综合征 1(4.0) 1(9.1) 慢性髓系白血病 1(4.0) 0 年龄/岁 31.96±13.63 30.64±21.34 t=0.225 0.210 HLA配型/例(%) χ2=1.140 0.439 半相合 16(64.0) 9(81.8) 全相合 9(36.0) 2(18.2) 预处理方案/例(%) χ2=0.340 0.720 FLu+CTX+ALG/ATG 14(56.0) 5(45.5) BU+CTX+ALG/ATG 11(44.0) 6(54.5) 供者类型/例(%) χ2=1.286 0.936 父亲 8(32.0) 3(27.3) 兄弟 7(28.0) 2(18.2) 姐妹 5(20.0) 2(18.2) 子女 3(12.0) 2(18.2) 母亲 1(4.0) 1(9.1) 非血缘 1(4.0) 1(9.1) 单个核细胞计数/(108/kg) 8.26(5.74，9.61) 10.31(5.90，13.02) Z=-1.570 0.114 CD34细胞计数/(106/kg) 5.15(3.58，7.26) 3.90(3.29，6.09) Z=-0.704 0.481 
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