中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2014年
12期
1100-1106
,共7页
薛文婧%江明%田猛%段显琳%曲建华%袁海龙%徐建丽%温丙昭%李玲
薛文婧%江明%田猛%段顯琳%麯建華%袁海龍%徐建麗%溫丙昭%李玲
설문청%강명%전맹%단현림%곡건화%원해룡%서건려%온병소%리령
移植物抗宿主病%造血干细胞移植,外周血%HLA单倍体%危险因素
移植物抗宿主病%造血榦細胞移植,外週血%HLA單倍體%危險因素
이식물항숙주병%조혈간세포이식,외주혈%HLA단배체%위험인소
Graft-versus-host disease%Allogeneic peripheral blood stem cell transplantation%HLA haploidentical%Risk factors
目的 分析亲缘HLA单倍体相合非体外去T细胞外周血造血干细胞移植(RHNT-PBSCT)后急性移植物抗宿主病(aGVHD)的临床特征及其相关危险因素.方法 选取2002年7月至2012年12月采用RHNT-PBSCT移植模式进行移植的104例患者,分析aGVHD发生率、发生部位以及危险因素,并与同期行同胞HLA全相合非体外去T细胞外周血造血干细胞移植(MSNT-PBSCT)的103例患者进行比较.结果 ①单倍体(RH)组aGVHD的累计发生率明显高于全相合(MS)组[(56.2±4.7)％对(34.0±3.6)％,P＜0.05],但Ⅱ～Ⅳ度、Ⅲ～Ⅳ度aGVHD的累计发生率两组间差异均无统计学意义[(39.5±2.9)％对(21.2±5.4)％,P＞0.05;(12.6±4.1)％对(10.8±2.4)％,P＞0.05].②皮肤型GVHD的累计发生率RH组明显高于MS组[(42.3±3.2)％对(17.5±2.3)％,P＜0.05],而肝脏型和消化道型aGVHD的累计发生率两组间差异无统计学意义[(7.7±2.1)％对(12.6±3.4)％,P＞0.05;(16.3±4.5)％对(10.3±2.5)％,P＞0.05].③RH组与MS组3年无病生存(DFS)率和总生存(OS)率分别为(63.0±5.5)％、(65.2±4.7)％及(74.2±5.4)％、(77.4±5.0)％,两组比较差异无统计学意义(P=0.078,P=0.052).④单因素分析显示aGVHD的发生与HLA配型(P=0.003)、相合位点数(P=0.002)有显著相关;多因素分析显示仅HLA配型是发生aGVHD的危险因素(HR=1.891,P=0.003).结论 采用RHNT-PBSCT移植模式,虽然aGVHD发生率明显高于MSNT-PBSCT,但重度aGVHD发生率无明显增高,发生部位以皮肤为主,表明此种移植模式是可行的.
目的 分析親緣HLA單倍體相閤非體外去T細胞外週血造血榦細胞移植(RHNT-PBSCT)後急性移植物抗宿主病(aGVHD)的臨床特徵及其相關危險因素.方法 選取2002年7月至2012年12月採用RHNT-PBSCT移植模式進行移植的104例患者,分析aGVHD髮生率、髮生部位以及危險因素,併與同期行同胞HLA全相閤非體外去T細胞外週血造血榦細胞移植(MSNT-PBSCT)的103例患者進行比較.結果 ①單倍體(RH)組aGVHD的纍計髮生率明顯高于全相閤(MS)組[(56.2±4.7)％對(34.0±3.6)％,P＜0.05],但Ⅱ～Ⅳ度、Ⅲ～Ⅳ度aGVHD的纍計髮生率兩組間差異均無統計學意義[(39.5±2.9)％對(21.2±5.4)％,P＞0.05;(12.6±4.1)％對(10.8±2.4)％,P＞0.05].②皮膚型GVHD的纍計髮生率RH組明顯高于MS組[(42.3±3.2)％對(17.5±2.3)％,P＜0.05],而肝髒型和消化道型aGVHD的纍計髮生率兩組間差異無統計學意義[(7.7±2.1)％對(12.6±3.4)％,P＞0.05;(16.3±4.5)％對(10.3±2.5)％,P＞0.05].③RH組與MS組3年無病生存(DFS)率和總生存(OS)率分彆為(63.0±5.5)％、(65.2±4.7)％及(74.2±5.4)％、(77.4±5.0)％,兩組比較差異無統計學意義(P=0.078,P=0.052).④單因素分析顯示aGVHD的髮生與HLA配型(P=0.003)、相閤位點數(P=0.002)有顯著相關;多因素分析顯示僅HLA配型是髮生aGVHD的危險因素(HR=1.891,P=0.003).結論 採用RHNT-PBSCT移植模式,雖然aGVHD髮生率明顯高于MSNT-PBSCT,但重度aGVHD髮生率無明顯增高,髮生部位以皮膚為主,錶明此種移植模式是可行的.
목적 분석친연HLA단배체상합비체외거T세포외주혈조혈간세포이식(RHNT-PBSCT)후급성이식물항숙주병(aGVHD)적림상특정급기상관위험인소.방법 선취2002년7월지2012년12월채용RHNT-PBSCT이식모식진행이식적104례환자,분석aGVHD발생솔、발생부위이급위험인소,병여동기행동포HLA전상합비체외거T세포외주혈조혈간세포이식(MSNT-PBSCT)적103례환자진행비교.결과 ①단배체(RH)조aGVHD적루계발생솔명현고우전상합(MS)조[(56.2±4.7)％대(34.0±3.6)％,P＜0.05],단Ⅱ～Ⅳ도、Ⅲ～Ⅳ도aGVHD적루계발생솔량조간차이균무통계학의의[(39.5±2.9)％대(21.2±5.4)％,P＞0.05;(12.6±4.1)％대(10.8±2.4)％,P＞0.05].②피부형GVHD적루계발생솔RH조명현고우MS조[(42.3±3.2)％대(17.5±2.3)％,P＜0.05],이간장형화소화도형aGVHD적루계발생솔량조간차이무통계학의의[(7.7±2.1)％대(12.6±3.4)％,P＞0.05;(16.3±4.5)％대(10.3±2.5)％,P＞0.05].③RH조여MS조3년무병생존(DFS)솔화총생존(OS)솔분별위(63.0±5.5)％、(65.2±4.7)％급(74.2±5.4)％、(77.4±5.0)％,량조비교차이무통계학의의(P=0.078,P=0.052).④단인소분석현시aGVHD적발생여HLA배형(P=0.003)、상합위점수(P=0.002)유현저상관;다인소분석현시부HLA배형시발생aGVHD적위험인소(HR=1.891,P=0.003).결론 채용RHNT-PBSCT이식모식,수연aGVHD발생솔명현고우MSNT-PBSCT,단중도aGVHD발생솔무명현증고,발생부위이피부위주,표명차충이식모식시가행적.
Objective To study the clinical features of acute graft-versus-host disease (aGVHD) and its risk factors for the related HLA-haploidentical non T cell-depleted in vitro peripheral hematopoietic stem cell transplantation (RHNT-PBSCT).Methods From July 2002 to December 2012,104 patients who underwent the RHNT-PBSCT were enrolled to analyze the incidences,location and its risk factors of aGVHD,compared with those of the 103 patients who received the HLA-matched sibling non T celldepleted in vitro PBSCT (MSNT-PBSCT) in the same period.Results ①The cumulative incidence of aGVHD in the RHNT-PBSCT group was significantly higher than the MSNT-PBSCT group [(56.2±4.7)％ vs (34±3.6)％,P＜0.05],but the cumulative incidences of Ⅱ-Ⅳ and Ⅲ-Ⅳ grade aGVHD had no significant difference between the two groups [(39.5±2.9)％ vs (21.2±5.4)％,P＞0.05; (12.6±4.1)％ vs (10.8±2.4)％,P＞0.05].②The cumulative incidence of cutaneous aGVHD was significantly higher in RHNT-PBSCT group than that in MSNT-PBSCT group [(42.3±3.2)％ vs (17.5±2.3)％,P＜0.05].The cumulative incidences of liver and gastrointestinal aGVHD between the two groups had no significant difference [(7.7±2.1)％ vs (12.6±3.4)％,P＞0.05; (16.3±4.5)％ vs (10.3±2.5)％,P＞0.05].③The 3-year disease free survival (DFS) and overall survival (OS) of RHNT-PBSCT group and MSNT-PBSCT group were (63±5.5)％,(65.2±4.7)％ and (74.2±5.4)％,(77.4±5)％ respectively,without significance (P=0.078,P=0.052).④ aGVHD occurrence with HLA haplotype (P=0.003) and matched loci (P=0.002) were significantly correlated by univariate analysis.Multivariate analysis showed that only the HLA typing is a risk factor for aGVHD (HR=1.891,P=0.03).Conclusion Although the incidence of total aGVHD in RHNT-PBSCT protocol is higher than that in MSNT-PBSCT,but there was no significance in severe aGVHD and cutaneous aGVHD was the common type,which indicates that RHNT-PBSCT protocol is feasible.
