CAJ | 학술논문

目的探讨异基因造血干细胞移植(allo-HSCT)治疗恶性血液病的预后相关因素.方法 1997年7月至2008年8月,对26例血液病患者行allo-HSCT,其中急性白血病(AL)14例,慢性髓系白血病(CML)10例,骨髓增生异常综合征(MDS)2例;移植供受体22例为同胞HLA全相合,4例为同胞HLA不全相合.结果所有患者达到稳定的供者植入,随访至今,累积总生存(OS)率为63.9%,累积无病生存(DFS)率为62.6%;15例(57.7%)发生移植物抗宿主病(GVHD),其中急性GVHD 8例(30.8%)[Ⅲ~Ⅳ度4例(15.4%)],慢性GVHD 7例;HLA全相合与HLA不全相合移植间GVHD发生率差异有统计学意义(P=0.014);复发4例;死亡7例.单因素分析结果显示,发生Ⅳ度GVHD、巨细胞病毒(CMV)感染是影响患者生存的高危因素,组问比较差异有统计学意义(P=0.05和P=0.027).结论 allo-HSCT是目前治疗恶性血液病的有效方法,提高allo-HSCT疗效的关键是控制移植相关并发症,特别是GVHD和感染.
목적 탐토이기인조혈간세포이식(allo-HSCT)치료악성혈액병적예후상관인소.방법 1997년7월지2008년8월,대26례혈액병환자행allo-HSCT,기중급성백혈병(AL)14례,만성수계백혈병(CML)10례,골수증생이상종합정(MDS)2례;이식공수체22례위동포HLA전상합,4례위동포HLA불전상합.결과 소유환자체도은정적공자식입,수방지금,루적총생존(OS)솔위63.9%,루적무병생존(DFS)솔위62.6%;15례(57.7%)발생이식물항숙주병(GVHD),기중급성GVHD 8례(30.8%)[Ⅲ~Ⅳ도4례(15.4%)],만성GVHD 7례;HLA전상합여HLA불전상합이식간GVHD발생솔차이유통계학의의(P=0.014);복발4례;사망7례.단인소분석결과현시,발생Ⅳ도GVHD、거세포병독(CMV)감염시영향환자생존적고위인소,조문비교차이유통계학의의(P=0.05화P=0.027).결론 allo-HSCT시목전치료악성혈액병적유효방법,제고allo-HSCT료효적관건시공제이식상관병발증,특별시GVHD화감염.
Objective To explore the clinical related prognostic factors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in treating malignant hematological diseases. Methods From September 1997 to August 2008,a total of 26 patients with hematological diseases were treated with allo-HSCT from HLA identical-sibling and haplo-identical donors in our hospital, including 14 patients with acute leukemias,10 with chronic myeloid leukemias,and 2 myelodysplastic syndromes. Results All patients achieved sustained full donor type engraftment. The cumulative overall survival (OS) was 63.9 %,and cumulative disease free survival (DFS) was 62.6 %. Fifteen patients had graft-versus-host disease (GVHD) (57.7 %),including 8 acute GVHD(aGVHD) (30.8 %) (grade Ⅲ-Ⅳ aGVHD was 15.4 %) and 7 chronic GVHD. GVHD between HLA identical-sibling and haplo-identical donors was different and there was statistic difference between the two groups (P=0.014). 4 patients relapsed,7 patients died. The univariate analysis showed OS were correlated with grade Ⅳ aGVHD (P=0.05) and CMV infection (P=0.027). Conclusion Allo-HSCT is effective for the cure of patients with malignant hematological diseases. The key to improve the efficacy of HSCT is to reduce the incidence of transplant-related complications,especially GVHD and infection.