CAJ | 학술논문

目的：分析异基因造血干细胞移植术后患者不同的死亡原因，对影响移植术后患者长期生存的不利因素进行探讨。方法采用经典改良白消安／环磷酰胺（Bu／Cy ）为基础的预处理方案，配合经动员的骨髓和（或）外周血造血干细胞输注，辅以预防感染、控制移植物抗宿主病（GVHD）等治疗，并观察造血干细胞移植治疗期间及随访过程中发生死亡的患者，进行死亡原因的回顾性分析。结果35例死亡患者中，11例疾病复发，15例严重感染（其中9例合并GV HD ，Ⅰ～Ⅱ度GV HD3例，Ⅲ～Ⅳ度GV HD者6例），2例造血功能衰竭，2例颅内出血，1例肺水肿，1例猝死，1例严重肠道GV HD ，1例疾病进展，1例溶血危象。移植后100 d内移植相关病死率为5．7％，移植后100 d至1年内移植相关病死率为8．1％，3年病死率为16．2％，5年病死率为16．7％。结论感染、GV HD和疾病复发是造血干细胞移植术后患者的最常见死因。移植后1年内容易发生致命性的感染，且感染常常合并GVHD ，恶性血液病患者合并慢性移植物抗宿主病（cGVHD）复发率较低。
목적：분석이기인조혈간세포이식술후환자불동적사망원인，대영향이식술후환자장기생존적불리인소진행탐토。방법채용경전개량백소안／배린선알（Bu／Cy ）위기출적예처리방안，배합경동원적골수화（혹）외주혈조혈간세포수주，보이예방감염、공제이식물항숙주병（GVHD）등치료，병관찰조혈간세포이식치료기간급수방과정중발생사망적환자，진행사망원인적회고성분석。결과35례사망환자중，11례질병복발，15례엄중감염（기중9례합병GV HD ，Ⅰ～Ⅱ도GV HD3례，Ⅲ～Ⅳ도GV HD자6례），2례조혈공능쇠갈，2례로내출혈，1례폐수종，1례졸사，1례엄중장도GV HD ，1례질병진전，1례용혈위상。이식후100 d내이식상관병사솔위5．7％，이식후100 d지1년내이식상관병사솔위8．1％，3년병사솔위16．2％，5년병사솔위16．7％。결론감염、GV HD화질병복발시조혈간세포이식술후환자적최상견사인。이식후1년내용역발생치명성적감염，차감염상상합병GVHD ，악성혈액병환자합병만성이식물항숙주병（cGVHD）복발솔교저。
Objective To analysis the different causes of death among patients who underwent allogeneic hematopoietic stem cell transplantation in order to explore the disadvantageous factors which affecting the long‐term survival after transplantation . Methods The planned conditioning regimen we used was BU/Cy and associated with mobilized peripheral blood and/or bone mar‐row stem cell .Meanwhile ,we used infection prevention and GVHD control methods .Throughout the treatment we observed the death patients during the allogeneic hematopoietic stem cell transplan‐tation and posttransplant ,however ,the causes of death were retrospectively analyzed .Results Among the 35 death cases ,the reason for 11 patients were relapse ,15 with serious infection (9 cases combine GVHD ,Ⅰ - Ⅱ GVHD 3 cases ,Ⅲ - Ⅳ GVHD 6 cases) ,2 patients underwent hematopoietic failure ,2 patients died of intracranial hemorrhage ,1 patient had pulmonary edema ,1 patient sudden death ,1 patient suffered from intestinal tract because of serious GVHD ,1 patient had a progression of disease ,and 1 hemolytic crisis .With a 100 days transplantation related mortality (TRM ) was 5 .7% ,and transplantation within 100 days to 1 year of TRM was 8 .1% .We received a 3‐year and 5‐year mortality rates of 16 .2% and 16 .7% ,respectively .Conclusion Infection ,GV HD and disease relapse are the most common causes of death a‐mong patients who underwent hematopoietic stem cell transplantation .Deadly infection is commonly observed within one year after transplantation and with which accompanied by the GVHD usually .Patients associated with cGVHD have a lower rate of disease re‐lapse .