白血病·淋巴瘤
白血病·淋巴瘤
백혈병·림파류
JOURNAL OF LEUKEMIA & LYMPHOMA
2013年
10期
589-592
,共4页
造血干细胞移植%非血缘供者%HLA匹配%生存分析%移植物抗宿主病
造血榦細胞移植%非血緣供者%HLA匹配%生存分析%移植物抗宿主病
조혈간세포이식%비혈연공자%HLA필배%생존분석%이식물항숙주병
Hematopoietic stem cell transplantation%Unrelated donors%HLA matching%Survival analysis%Graft vs host disease
目的 探讨非血缘造血干细胞移植中HLA是否完全匹配对疾病预后的影响.方法 回顾性分析81例进行非血缘造血干细胞移植治疗的恶性血液病(包括白血病、骨髓增生异常综合征、淋巴瘤)患者资料.分为HLA高分辨全相合组(53例)与HLA非全相合组(28例).比较两组患者的移植后总生存(OS)、治疗相关死亡率(TRM)、复发率(RR)、移植物抗宿主病(GVHD)发生率,并进一步深入讨论原因.结果 81例患者的中位随访时间为11.9个月(0.3～ 57.4个月).HLA全相合组与HLA非全相合组间OS率(66.0％比46.4％,P=0.031)、TRM(17.0％比42.9％,P=0.017)差异均有统计学意义,而RR差异无统计学意义(14.3％比32.1％,P=0.111).经多因素分析显示,HLA全相合与否是TRM独立预后因素,但非OS的独立预后因素.HLA全相合组与HLA非全相合组间急性GVHD(22.9％比40.9％,P=0.122)与慢性GVHD的发生率(40.0％比46.7％,P=0.655)差异无统计学意义,而重度急性GVHD发生率(4.2％比31.8％,P=0.005)差异有统计学意义.结论 非亲缘造血干细胞移植中HLA-A、HLA-B、DRB1位点高分辨匹配程度影响OS、TRM及重度急性GVHD发生率,并不影响RR、急性GVHD与慢性GVHD整体发生率.
目的 探討非血緣造血榦細胞移植中HLA是否完全匹配對疾病預後的影響.方法 迴顧性分析81例進行非血緣造血榦細胞移植治療的噁性血液病(包括白血病、骨髓增生異常綜閤徵、淋巴瘤)患者資料.分為HLA高分辨全相閤組(53例)與HLA非全相閤組(28例).比較兩組患者的移植後總生存(OS)、治療相關死亡率(TRM)、複髮率(RR)、移植物抗宿主病(GVHD)髮生率,併進一步深入討論原因.結果 81例患者的中位隨訪時間為11.9箇月(0.3～ 57.4箇月).HLA全相閤組與HLA非全相閤組間OS率(66.0％比46.4％,P=0.031)、TRM(17.0％比42.9％,P=0.017)差異均有統計學意義,而RR差異無統計學意義(14.3％比32.1％,P=0.111).經多因素分析顯示,HLA全相閤與否是TRM獨立預後因素,但非OS的獨立預後因素.HLA全相閤組與HLA非全相閤組間急性GVHD(22.9％比40.9％,P=0.122)與慢性GVHD的髮生率(40.0％比46.7％,P=0.655)差異無統計學意義,而重度急性GVHD髮生率(4.2％比31.8％,P=0.005)差異有統計學意義.結論 非親緣造血榦細胞移植中HLA-A、HLA-B、DRB1位點高分辨匹配程度影響OS、TRM及重度急性GVHD髮生率,併不影響RR、急性GVHD與慢性GVHD整體髮生率.
목적 탐토비혈연조혈간세포이식중HLA시부완전필배대질병예후적영향.방법 회고성분석81례진행비혈연조혈간세포이식치료적악성혈액병(포괄백혈병、골수증생이상종합정、림파류)환자자료.분위HLA고분변전상합조(53례)여HLA비전상합조(28례).비교량조환자적이식후총생존(OS)、치료상관사망솔(TRM)、복발솔(RR)、이식물항숙주병(GVHD)발생솔,병진일보심입토론원인.결과 81례환자적중위수방시간위11.9개월(0.3～ 57.4개월).HLA전상합조여HLA비전상합조간OS솔(66.0％비46.4％,P=0.031)、TRM(17.0％비42.9％,P=0.017)차이균유통계학의의,이RR차이무통계학의의(14.3％비32.1％,P=0.111).경다인소분석현시,HLA전상합여부시TRM독립예후인소,단비OS적독립예후인소.HLA전상합조여HLA비전상합조간급성GVHD(22.9％비40.9％,P=0.122)여만성GVHD적발생솔(40.0％비46.7％,P=0.655)차이무통계학의의,이중도급성GVHD발생솔(4.2％비31.8％,P=0.005)차이유통계학의의.결론 비친연조혈간세포이식중HLA-A、HLA-B、DRB1위점고분변필배정도영향OS、TRM급중도급성GVHD발생솔,병불영향RR、급성GVHD여만성GVHD정체발생솔.
Objective To assess the impact of HLA-A,HLA-B,HLA-DRB1 matching on the prognosis of hematopoietic stem cell transplantation from unrelated donors.Methods A total of 81 patients with hematological malignancies including leukemia,myelodysplastic syndrome(MDS)and lymphoma who underwent hematopoietic stem cell transplantation from unrelated donors from 2007 to 2012 in our department were included in this retrospective analysis.Patients were classified into HLA match group(n=53)and HLA mismatch group(n=28)according to the HLA high-resolution matching.The overall survival (OS),treatmentrelated mortality(TRM),relapse rate(RR),graft-versus-host disease(GVHD)incidence were analyzed.Results The 81 patients were analyzed with a median follow-up of 11.9 months(0.3 to 57.4 months).The OS (66.0％vs 46.4％,P=0.031)and TRM(17.0％vs 42.9％,P=0.017)were significantly different between the HLA match group and HLA mismatch group,while the RR had no significant difference(14.3％vs 32.1％,P=0.111).Multivariate analysis showed HLA matching was an independent prognostic factor of TRM,but not OS.There's no significant difference of aGVHD(22.9％vs 40.9％,P=0.122)and cGVHD (40.0％vs 46.7％,P=0.655)incidence between the two groups,but the incidence of severe aGVHD in HLA match group were much lower(4.2％vs 25.0％,P=0.005)than HLA mismatch group.Conclusion the high-resolution matching of HLA-A,-B,DRB1 affect OS,TRM and the incidence of severe aGVHD in unrelated hematopoietic stem cell transplantation,but not affect RR,the incidence of aGVHD and cGVHD.
