中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2014年
5期
428-433
,共6页
黎美章%章卫平%王健民%宋献民%杨建民%倪雄%杨丹%陈莉%陈洁
黎美章%章衛平%王健民%宋獻民%楊建民%倪雄%楊丹%陳莉%陳潔
려미장%장위평%왕건민%송헌민%양건민%예웅%양단%진리%진길
白血病%外周血干细胞移植%移植物抗宿主病%预后
白血病%外週血榦細胞移植%移植物抗宿主病%預後
백혈병%외주혈간세포이식%이식물항숙주병%예후
Leukemia%Peripheral blood stem cell transplantation%Graft versus host disease%Prognosis
目的 探讨异基因外周血干细胞移植(allo-PBSCT)后急性移植物抗宿主病(aGVHD)和慢性GVHD (cGVHD)的严重程度对白血病患者预后的影响及发生的相关危险因素.方法 回顾性分析2001年1月1日至2011年12月31日接受allo-PBSCT的231例白血病患者的临床资料.分析aGVHD、cGVHD的发生率及其对患者移植后总生存(OS)率、无病生存(DFS)率、移植相关死亡(TRM)率和复发率(RR)的影响.结果 ①可评估的224例患者中85例发生aGVHD,其中Ⅰ度46例,Ⅱ度25例,Ⅲ～Ⅳ度14例.生存100 d以上者213例,109例发生cGVHD,其中局限型84例,广泛型25例.②0～Ⅰ度aGVHD患者3年OS和DFS率高于Ⅱ～Ⅳ度aGVHD患者(分别为69.5％和60.7％对33.6％和33.7％,P值均＜0.01);前者3年TRM率低于后者(15.0％对56.7％,P＜0.01).③局限型cGVHD患者5年OS率高于无cGVHD及广泛型cGVHD患者(79.8％对55.6％,P＜0.01;79.8％对56.4％,P=0.038);局限型cGVHD患者5年TRM率低于广泛型cGVHD患者(14.1％对41.1％,P=0.018);无cGVHD患者5年RR不仅高于局限型cGVHD患者(47.2％对10.9％,P＜0.01),也高于广泛型cGVHD患者(47.2％对12.4％,P=0.007).④多因素分析提示供者类型、清髓性预处理是allo-PBSCT后发生aGVHD的主要危险因素;而aGVHD又是发生cGVHD的唯一危险因素.结论 aGVHD对白血病患者allo-PBSCT后长期生存有明显不良影响,尤其是Ⅲ～Ⅳ度aGVHD对患者的影响更加显著;而局限型cGVHD则是患者长期生存的有益因素,可能与之伴随的移植物抗白血病效应降低白血病复发相关.
目的 探討異基因外週血榦細胞移植(allo-PBSCT)後急性移植物抗宿主病(aGVHD)和慢性GVHD (cGVHD)的嚴重程度對白血病患者預後的影響及髮生的相關危險因素.方法 迴顧性分析2001年1月1日至2011年12月31日接受allo-PBSCT的231例白血病患者的臨床資料.分析aGVHD、cGVHD的髮生率及其對患者移植後總生存(OS)率、無病生存(DFS)率、移植相關死亡(TRM)率和複髮率(RR)的影響.結果 ①可評估的224例患者中85例髮生aGVHD,其中Ⅰ度46例,Ⅱ度25例,Ⅲ～Ⅳ度14例.生存100 d以上者213例,109例髮生cGVHD,其中跼限型84例,廣汎型25例.②0～Ⅰ度aGVHD患者3年OS和DFS率高于Ⅱ～Ⅳ度aGVHD患者(分彆為69.5％和60.7％對33.6％和33.7％,P值均＜0.01);前者3年TRM率低于後者(15.0％對56.7％,P＜0.01).③跼限型cGVHD患者5年OS率高于無cGVHD及廣汎型cGVHD患者(79.8％對55.6％,P＜0.01;79.8％對56.4％,P=0.038);跼限型cGVHD患者5年TRM率低于廣汎型cGVHD患者(14.1％對41.1％,P=0.018);無cGVHD患者5年RR不僅高于跼限型cGVHD患者(47.2％對10.9％,P＜0.01),也高于廣汎型cGVHD患者(47.2％對12.4％,P=0.007).④多因素分析提示供者類型、清髓性預處理是allo-PBSCT後髮生aGVHD的主要危險因素;而aGVHD又是髮生cGVHD的唯一危險因素.結論 aGVHD對白血病患者allo-PBSCT後長期生存有明顯不良影響,尤其是Ⅲ～Ⅳ度aGVHD對患者的影響更加顯著;而跼限型cGVHD則是患者長期生存的有益因素,可能與之伴隨的移植物抗白血病效應降低白血病複髮相關.
목적 탐토이기인외주혈간세포이식(allo-PBSCT)후급성이식물항숙주병(aGVHD)화만성GVHD (cGVHD)적엄중정도대백혈병환자예후적영향급발생적상관위험인소.방법 회고성분석2001년1월1일지2011년12월31일접수allo-PBSCT적231례백혈병환자적림상자료.분석aGVHD、cGVHD적발생솔급기대환자이식후총생존(OS)솔、무병생존(DFS)솔、이식상관사망(TRM)솔화복발솔(RR)적영향.결과 ①가평고적224례환자중85례발생aGVHD,기중Ⅰ도46례,Ⅱ도25례,Ⅲ～Ⅳ도14례.생존100 d이상자213례,109례발생cGVHD,기중국한형84례,엄범형25례.②0～Ⅰ도aGVHD환자3년OS화DFS솔고우Ⅱ～Ⅳ도aGVHD환자(분별위69.5％화60.7％대33.6％화33.7％,P치균＜0.01);전자3년TRM솔저우후자(15.0％대56.7％,P＜0.01).③국한형cGVHD환자5년OS솔고우무cGVHD급엄범형cGVHD환자(79.8％대55.6％,P＜0.01;79.8％대56.4％,P=0.038);국한형cGVHD환자5년TRM솔저우엄범형cGVHD환자(14.1％대41.1％,P=0.018);무cGVHD환자5년RR불부고우국한형cGVHD환자(47.2％대10.9％,P＜0.01),야고우엄범형cGVHD환자(47.2％대12.4％,P=0.007).④다인소분석제시공자류형、청수성예처리시allo-PBSCT후발생aGVHD적주요위험인소;이aGVHD우시발생cGVHD적유일위험인소.결론 aGVHD대백혈병환자allo-PBSCT후장기생존유명현불량영향,우기시Ⅲ～Ⅳ도aGVHD대환자적영향경가현저;이국한형cGVHD칙시환자장기생존적유익인소,가능여지반수적이식물항백혈병효응강저백혈병복발상관.
Objective To analyze the impact of the occurrence and severity of acute and chronic graft versus host disease (GVHD) on the long-term outcome of allogeneic peripheral blood stem cell transplantation (allo-PBSCT) for leukemia.Methods A total of 231 patients with leukemia,who underwent allo-HSCT in Changhai Hospital from Jan 1st,2001 to Dec 31th,2011,were retrospectively analyzed.The overall survival (OS),disease-free survival (DFS),transplantation-related mortality (TRM) and relapse rate (RR) were estimated according to the degree of acute and chronic GVHD.Results ① Among the 224 assessable patients,aGVHD was observed in 85 patients,in which 46 developed grade Ⅰ,25 grade Ⅱ and 14 grade]]Ⅲ-Ⅳ.A total of 213 patients who survived beyond 100 days,cGVHD was observed in 109 patients,in which 84 developed limited cGVHD and 25 extensive cGVHD.②The incidence of 3-year OS and EFS of patients with aGVHD grade 0-Ⅰ was significantly higher than that of grade Ⅱ-Ⅳ (69.5％ vs 33.6％,P＜0.01; 60.7％ vs 33.7％,P＜0.01).The 3-year TRM of patients with 0-Ⅰ grade aGVHD was significantly lower than that of the grade Ⅱ-Ⅳ group (15.0％ vs 56.7％,P＜0.01).③The 5-year OS of patients with limited cGVHD was higher than patients without or with extensive cGVHD (79.8％ vs 55.6％ and 56.4％,P＜0.01 and P=0.038,respectively).The 5-year TRM in patients with extensive cGVHD was higher than patients with limited cGVHD (14.1％ vs 41.1％,P=0.018).However,the 5-year RR in patients without cGVHD was higher than patients with limited cGVHD or extensive cGVHD (47.2％ vs 10.9％ and 12.4％,P＜0.01 and P=0.007,respectively).④The COX analysis showed that unrelated donor and myeloablative conditioning regimen were main factors affecting aGVHD; Meanwhile,aGVHD was the only factor affecting the cGVHD.Conclusion Our results showed that the patients with acute GVHD tended to have poor outcomes,especially with grade Ⅲ-Ⅳ.On the contrary,the patients with limited cGVHD had lower RR and a long-term DFS.
