地中海贫血高血清铁蛋白与造血干细胞移植后血细胞恢复的关系

Correlation between pretransplant high serum ferritin and blood cell recovery after hematopoietic stem cell transplantation for β-thalassemia major

目的研究重型β地中海贫血(地贫)造血干细胞移植(HSCT)植入后血细胞减少(CPE)的影响因素。方法对2009年1月1日-2015年6月30日在本中心行7/8 HLA相合HSCT治疗的61例地贫患者进行了回顾性分析。61例患者分为CPE组(n=38)和无CPE组(n=23),运用单因素和多因素回归分析对两组中移植前铁蛋白(PTSF)、供者年龄、受者年龄与CPE的相关性。结果在单因素分析中证明PTSF为CPE的危险因素。CPE组PTSF水平明显高于无CPE组(3927.9±1314.9 ng/mL vs 2291.0±994.4 ng/mL,P=0.000)。同样的结果在多因素回归分析中也被证实(P=0.001)。运用R语言(R 2.15.2)校正两组中PTSF界限值为2500 ng/mL。结论高PTSF是7/8 HLA相合地贫HSCT发生CPE的高危因素,在地贫患者接受7/8 HLA相合HSCT时,PTSF应降至2500 ng/mL以下。

Objective Purpose To find out the causes of Cytopenia post engraftment（ CPE） in hematopoietic stem cell transplantation（ HSCT） for patients with β-thalassemia major（（3-TM）.Methods We retrospectively analyzed 61 consecutive β-TM patients who underwent 7/8 HLA matched HSCT from January 1, 2009 to June 30,2015. Thirty-eight patients suffered from CPE and the remainder（n= 23） without CPE. The effect of pre-transplant ferritin（PTSF） and recipient and donor age on CPE were analyzed in the two groups. The CPE was defined as white blood cell counts less than 3.0 x 109/L for four weeks or longer without infection of cytomegalovirus, human parvovirus B19 virus and EpsteinBarr virus. Results In univariate analysis, the PTSF level was the risk factor for CPE and significantly higher in CPE group than no-CPE group（3927.9 ± 1314.9 ng/mL vs 2291.0 ± 994.4 ng/mL,P=0.000）. The result was also proved by multi-factor binary regression analysis（P =0.001）. The optimal value of PTSF level by R language（R 2. 15.2） is 2500 ng/mL, which is cut off value in the two groups. Conclusions The current study indicated that high PTSF level is a high-risk factor of CPE forβ-TM patients who underwent 7/8 HLA-matched HSCT, and PTSF should be reduced below 2500 ng/L if the 7/8 matched HSCT must be done.