白血病·淋巴瘤
白血病·淋巴瘤
백혈병·림파류
JOURNAL OF LEUKEMIA & LYMPHOMA
2012年
12期
716-719,726
,共5页
窦汉波%山洁慧%王苓%唐暐%胡炯
竇漢波%山潔慧%王苓%唐暐%鬍炯
두한파%산길혜%왕령%당위%호형
造血干细胞移植%非血缘供者%移植物抗宿主病%抗胸腺细胞球蛋白%预防
造血榦細胞移植%非血緣供者%移植物抗宿主病%抗胸腺細胞毬蛋白%預防
조혈간세포이식%비혈연공자%이식물항숙주병%항흉선세포구단백%예방
Hematopoietic stem cell transplantation%Unrelated donors%Graft vs host disease%Antithymocyte globulin%Prophylaxis
目的 探讨非血缘造血干细胞移植中应用抗胸腺细胞球蛋白(ATG)预防移植物抗宿主病(GVHD)的临床疗效.方法 回顾性分析1999年1月至2011年12月行非血缘造血干细胞移植患者治疗的恶性血液病(包括白血病、骨髓增生异常综合征、淋巴瘤)92例患者资料.分为ATG预防组(66例)和无ATG组(26例).ATG剂量为1.5 mg/kg,移植前第4天至移植前第1天.比较两组急性GVHD(aGVHD)和慢性GVHD(cGVHD)发生率,分析aGVHD与cGVHD发生的危险因素,并比较ATG预防对移植后总生存(OS)、治疗相关死亡(TRM)率、复发率的影响.结果 Ⅱ～Ⅳ度aGVHD和Ⅲ～Ⅳ度aGVHD发生率差异无统计学意义[26.7％(16/60)比44.0％(11 /25),P=0.12；13.3 ％(8/60)比8.0％(2/25),P=0.74].ATG组cGVHD及广泛型cGVHD发生率明显低于无ATG组[34.0％(17/50)比72.2％(13/18),P=0.005；10.0％(5/50)比44.4％(8/18),P=0.005].多因素分析显示ATG预防能降低cGVHD发生[相对危险度(RR)=0.22,95％CI 0.081 ～ 0.599;P=0.003],人类白细胞抗原(HLA)不完全相合增加cGVDH发生率(RR=3.25,95％CI1.39 ～ 7.61；P=0.007).并且ATG预防显著降低广泛型cGVHD发生(RR=0.05,95％CI0.009～0.240；P＜ 0.001).92例患者中位随访时间12个月(1 ～ 84个月).ATG预防组和无ATG组间OS率(60.4％比43.1％,P=0.41)、TRM率(19.8％比34.3％,P=0.43)、复发率(40.6％比33.6％,P=0.54)差异均无统计学意义.结论 总量6 mg/ kg的ATG预防可显著降低非血缘造血干细胞移植患者cGVHD及广泛型cGVHD的发生率,不增加疾病复发,对OS及TRM亦无影响.
目的 探討非血緣造血榦細胞移植中應用抗胸腺細胞毬蛋白(ATG)預防移植物抗宿主病(GVHD)的臨床療效.方法 迴顧性分析1999年1月至2011年12月行非血緣造血榦細胞移植患者治療的噁性血液病(包括白血病、骨髓增生異常綜閤徵、淋巴瘤)92例患者資料.分為ATG預防組(66例)和無ATG組(26例).ATG劑量為1.5 mg/kg,移植前第4天至移植前第1天.比較兩組急性GVHD(aGVHD)和慢性GVHD(cGVHD)髮生率,分析aGVHD與cGVHD髮生的危險因素,併比較ATG預防對移植後總生存(OS)、治療相關死亡(TRM)率、複髮率的影響.結果 Ⅱ～Ⅳ度aGVHD和Ⅲ～Ⅳ度aGVHD髮生率差異無統計學意義[26.7％(16/60)比44.0％(11 /25),P=0.12；13.3 ％(8/60)比8.0％(2/25),P=0.74].ATG組cGVHD及廣汎型cGVHD髮生率明顯低于無ATG組[34.0％(17/50)比72.2％(13/18),P=0.005；10.0％(5/50)比44.4％(8/18),P=0.005].多因素分析顯示ATG預防能降低cGVHD髮生[相對危險度(RR)=0.22,95％CI 0.081 ～ 0.599;P=0.003],人類白細胞抗原(HLA)不完全相閤增加cGVDH髮生率(RR=3.25,95％CI1.39 ～ 7.61；P=0.007).併且ATG預防顯著降低廣汎型cGVHD髮生(RR=0.05,95％CI0.009～0.240；P＜ 0.001).92例患者中位隨訪時間12箇月(1 ～ 84箇月).ATG預防組和無ATG組間OS率(60.4％比43.1％,P=0.41)、TRM率(19.8％比34.3％,P=0.43)、複髮率(40.6％比33.6％,P=0.54)差異均無統計學意義.結論 總量6 mg/ kg的ATG預防可顯著降低非血緣造血榦細胞移植患者cGVHD及廣汎型cGVHD的髮生率,不增加疾病複髮,對OS及TRM亦無影響.
목적 탐토비혈연조혈간세포이식중응용항흉선세포구단백(ATG)예방이식물항숙주병(GVHD)적림상료효.방법 회고성분석1999년1월지2011년12월행비혈연조혈간세포이식환자치료적악성혈액병(포괄백혈병、골수증생이상종합정、림파류)92례환자자료.분위ATG예방조(66례)화무ATG조(26례).ATG제량위1.5 mg/kg,이식전제4천지이식전제1천.비교량조급성GVHD(aGVHD)화만성GVHD(cGVHD)발생솔,분석aGVHD여cGVHD발생적위험인소,병비교ATG예방대이식후총생존(OS)、치료상관사망(TRM)솔、복발솔적영향.결과 Ⅱ～Ⅳ도aGVHD화Ⅲ～Ⅳ도aGVHD발생솔차이무통계학의의[26.7％(16/60)비44.0％(11 /25),P=0.12；13.3 ％(8/60)비8.0％(2/25),P=0.74].ATG조cGVHD급엄범형cGVHD발생솔명현저우무ATG조[34.0％(17/50)비72.2％(13/18),P=0.005；10.0％(5/50)비44.4％(8/18),P=0.005].다인소분석현시ATG예방능강저cGVHD발생[상대위험도(RR)=0.22,95％CI 0.081 ～ 0.599;P=0.003],인류백세포항원(HLA)불완전상합증가cGVDH발생솔(RR=3.25,95％CI1.39 ～ 7.61；P=0.007).병차ATG예방현저강저엄범형cGVHD발생(RR=0.05,95％CI0.009～0.240；P＜ 0.001).92례환자중위수방시간12개월(1 ～ 84개월).ATG예방조화무ATG조간OS솔(60.4％비43.1％,P=0.41)、TRM솔(19.8％비34.3％,P=0.43)、복발솔(40.6％비33.6％,P=0.54)차이균무통계학의의.결론 총량6 mg/ kg적ATG예방가현저강저비혈연조혈간세포이식환자cGVHD급엄범형cGVHD적발생솔,불증가질병복발,대OS급TRM역무영향.
Objective To assess the impact of antithymocyte globulin (ATG) on the incidence of graft-vs-host disease (GVHD) in hematopoietic stem cell transplantation from unrelated donors.Methods A total of 92 patients with hematological malignancies including leukemia,myelodysplastic syndrome (MDS) and lymphoma who underwent hematopoietic stem cell transplantation from unrelated donors from January 1999 to December 2011 were included in this retrospective analysis.Patients were classified into ATG group (n =66)and non-ATG group (n =26) according to the GVHD prophylaxis regimen.The incidence of acute GVHD (aGVHD) and chronic GVHD (cGVHD),risk factors of aGVHD and cGVHD and impact of ATG on the overall survival (OS),treatment related mortality (TRM) and relapse rate were analyzed.Results Grade Ⅱ-Ⅳ aGVHD (26.7 ％ vs 44.0 ％,P=0.12) or grade Ⅲ-Ⅳ aGVHD (13.3 ％ vs 8.0 ％,P =0.74) were not significantly different between ATG and non-ATG group.However,the incidence of cGVHD in the ATG group was significantly lower (34.0 ％ vs 72.2 ％,P =0.005) than non-ATG group.The incidence of extensive cGVHD was also significantly reduced (10.0 ％ vs 44.4 ％,P =0.005) compared to non-ATG group.In multivariate analysis,the use of ATG prophylaxis significantly decreased the cGVHD (RR =0.22,95 ％CI 0.081-0.599,P =0.003) while one allele mismatch of human leukocyte antigen (HLA) was associated with increased risk of cGVHD (RR =3.25,95 ％ CI 1.39-7.61,P =0.007).As to the extensive cGVHD,the use of ATG was the only independent factor (RR =0.05,95 ％ CI 0.009-0.240,P ＜ 0.001).With a median follow-up of 12 months (1-84 months),ATG prophylaxis had no impact on OS rate (60.4 ％ vs 43.1％,P =0.41),TRM rate (19.8 ％ vs 34.3 ％,P =0.43) and relapse rate (40.6 ％ vs 33.6 ％,P=0.54).Conclusion In hematopoietic stem cell transplantation from unrelated donors,ATG prophylaxis total dose of 6 mg/kg may significantly decrease the incidence of cGVHD and extensive cGVHD without increase of TRMand relapse rate and impairment of OS.
