异基因造血干细胞移植治疗白血病的应用及临床预后分析

Application and Clinical Prognosis Analysis of Gene Hematopoietic Stem Cell Transplantation in Treatment of Leukemia

目的分析异基因造血干细胞移植治疗白血病的应用及临床预后。方法以本院2018年7月至2019年12月接受异基因造血干细胞移植治疗的白血病患者70例作为研究对象,其中单倍体移植34例,同胞全相合移植24例,无关供者移植12例,对比分析异基因造血干细胞移植治疗的临床疗效及预后。结果70例患者中粒系植入成功68例,中位植入时间12d,败血症导致未重建死亡2例,巨核系植入成功66例,中位植入时间13d,血小板植入不良2例,血小板原发植入失败2例。移植后的100d内,发生急性GVHD患者34例,其中Ⅰ级12例,Ⅱ级12例,Ⅲ-Ⅳ级10例。发生慢性GVHD患者29例,其中轻度19例,中重度10例。70例患者自预处理开始8例发生感染,随访后,23例发生CMV血症,其中14例发生在移植期一百天内,7例发生移植一百天后,患者经治疗后成功转阴。血型不合(OR=9.5232,95%,CI2.5352-39.5236,P=0.0002),发生GVHD(OR=6.5236,95%,CI1.5203-42.6352,P=0.0425)是患者发生CMV的独立危险因素。单体与同胞全相移植两组患者OS率、急性与慢性GVHD发生率及复发率均无显著差异,P>0.05。结论单倍体移植与同胞全相合移植异基因造血干细胞移植治疗白血病疗效确切,且安全性高,值得应用与推广。

Objective To analyzed application and clinical prognosis of allogeneic hematopoietic stem cell transplantation in treatment of leukemia.Methods The paper chose 70 leukemia patients was treated with allogeneic hematopoietic stem cell transplantation in our hospital from July 2018 to December 2019 as research objects,including 34 haploid transplants,24 sibling transplants,and 12 unrelated donors.Clinical effect and prognosis of allogeneic hematopoietic stem cell transplantation was compared and analyzed.Results Among 70 patients,68 cases had successful granule implantation,with median implantation time of 12 days,2 cases had unreconstructed death due to sepsis,66 cases had megakaryocyte implantation,with median implantation time of 13 days,and 2 cases had platelet implantation.2 cases had platelet primary implantation fail.Within 100 days after transplantation,34 cases had acute GVHD,including 12 cases of grade I,12 cases of grade II,and 10 cases of grade III-IV.29 cases had chronic GVHD,of which 19 were mild and 10 moderately severe.8 cases of 70 patients developed infections since pretreatment.After follow-up,23 cases developed CMVemia,14 of which occurred within 100 days of transplantation,and 7 cases occurred 100 days after transplantation,patients successfully turned negative after treatment.Blood group incompatibility(OR=9.5232,95%,CI2.5352-39.5236,P=0.0002)and GVHD(OR=6.5236,95%,CI1.5203-42.6352,P=0.0425)were independent risk factors for development of CMV,OS rate,acute and chronic GVHD incidence,and recurrence rate showed no significant difference between two groups of monosomic and sibling full-phase transplantation,P>0.05.Conclusion Haplotransplantation and sibling allogeneic hematopoietic stem cell transplantation can achieve definite effect in treating leukemia with high safety,which is worthy of application and promotion.