CAJ | 학술논문

目的探讨单倍型造血干细胞移植治疗移植前处于不同肿瘤负荷的血液恶性肿瘤的安全性及影响生存的危险因素.方法回顾性分析2007年1月至2013年5月70例接受单倍型造血干细胞移植的血液恶性肿瘤患者临床资料,根据移植前肿瘤残留的情况分成低肿瘤负荷组、中肿瘤负荷组、高肿瘤负荷组,分析移植前肿瘤残留对生存的影响.同时分析这些患者的预处理方案、移植相关并发症及复发等情况.结果随访截至2014年1月1日,中位随访34.05个月(7.4～83.6个月).全部患者均获得植入,Ⅱ～Ⅳ度急性移植物抗宿主病(GVHD)发生率47.14％(33/70),其中Ⅲ～Ⅳ度急性GVHD发生率21.4％(15/70).慢性广泛型GVHD发生率20.0％(14/70).至随访期结束总生存率68.6％,移植相关死亡率12.8％,复发死亡率18.6％.低肿瘤负荷组、中肿瘤负荷组、高肿瘤负荷组2年生存率分别为91.7％、72.7％、33.3％,移植前肿瘤残留是影响生存的高危因素(移植前中、高肿瘤负荷组2年生存率比较,P=0.016).结论单倍型造血干细胞移植在血液恶性肿瘤的治疗中是安全有效的,移植前肿瘤残留为影响患者总生存及导致复发的重要原因,对预后不良的血液恶性肿瘤患者,应该在缓解后尽早接受造血干细胞移植来减少移植后的复发,提高总生存.
목적 탐토단배형조혈간세포이식치료이식전처우불동종류부하적혈액악성종류적안전성급영향생존적위험인소.방법 회고성분석2007년1월지2013년5월70례접수단배형조혈간세포이식적혈액악성종류환자림상자료,근거이식전종류잔류적정황분성저종류부하조、중종류부하조、고종류부하조,분석이식전종류잔류대생존적영향.동시분석저사환자적예처리방안、이식상관병발증급복발등정황.결과 수방절지2014년1월1일,중위수방34.05개월(7.4～83.6개월).전부환자균획득식입,Ⅱ～Ⅳ도급성이식물항숙주병(GVHD)발생솔47.14％(33/70),기중Ⅲ～Ⅳ도급성GVHD발생솔21.4％(15/70).만성엄범형GVHD발생솔20.0％(14/70).지수방기결속총생존솔68.6％,이식상관사망솔12.8％,복발사망솔18.6％.저종류부하조、중종류부하조、고종류부하조2년생존솔분별위91.7％、72.7％、33.3％,이식전종류잔류시영향생존적고위인소(이식전중、고종류부하조2년생존솔비교,P=0.016).결론 단배형조혈간세포이식재혈액악성종류적치료중시안전유효적,이식전종류잔류위영향환자총생존급도치복발적중요원인,대예후불량적혈액악성종류환자,응해재완해후진조접수조혈간세포이식래감소이식후적복발,제고총생존.
Objective To explore the efficiency and prognosis of hematological malignancies treated by haploidentical hematopoietic stem cell transplantation.Methods 70 patients who received haploidentical hematopoietic stem cell transplantation were analyzed retrospectively.According to tumor burden before transplantation,the patients were divided into three groups,the low tumor burden group,the mediate tumor burden group and the high tumor burden group.And then the effection of the tumor burden to survival was analyzed,and the engraftment,GVHD,infection,conditioning related toxicity,relapse and survival rate were also observed.Results The follow-up was terminated on January 1,2014.Follow-ups were performed for a median of 34.05 (7.4-83.6) months after transplantation.All patients achieved engraftments.The cumulative incidence of GVHD of grades 2-4 was 47.14 ％ (33/70) and that of grades 3-4 was 21.4 ％ (15/70).The chronic extensive GVHD was 20.0 ％ (14/70).The overall survival was 68.6 ％.Transplant-related mortality was 12.8 ％ and the relapse was 18.6 ％.The overall survivals in low tumor burden group,mediate tumor burden group,high tumor burden group were 91.67 ％,72.7 ％,33.3 ％ respectively.By SPSS 20.0,tumor burden was the high risk factor affecting the survival (low tumor group vs high tumor group,mediate tumor group vs high tumor group,low tumor group vs high tumor group,P =0.000,P =0.038,P =0.016).Conclusions Haploidentical hematopoietic stem cell transplantation in hematological malignancies is safe and effective.And for hematological malignancies with poor prognosis disease,it should be accepted the HSCT as soon as possible after remission in order to reduce the recurrence rate of malignancy.