96例异基因造血干细胞移植后5年总生存率的危险因素分析

Analysis of Risk Factors for Overall Survival at 5 Years in 96 Patients after Allogeneic Hematopoietic Cell Transplantation

本研究探索96例异基因造血干细胞移植(allo-HSCT)后5年总生存的主要危险因素,以便早期采取积极有效的防治措施,更好地提高移植疗效。对96例allo-HSCT患者的资料进行回顾性分析。选择年龄、性别、移植时疾病状态、HLA配型、供者类型、供受者血型、预处理方案、急性移植物抗宿主病(aGVHD)、出血性膀胱炎(HC)、肝静脉闭塞(VOD)、间质性肺炎(IP)等11个临床参数,进行Cox单因素分析。将在单因素分析中p<0.1作为有统计学意义的因素进行Cox多因素回归分析。aGVHD的累积发生率和患者的生存率采用Kaplan-Meier曲线计算。结果表明:除1例患者造血干细胞未植活外,其余95例患者均达到稳定植活,ANC≥0.5×109/L的中位时间为移植后13天。96例中有42例发生Ⅰ-Ⅳ度aGVHD(43.75%),其中Ⅰ度11例(11.46%),Ⅱ度19例(19.79%);Ⅲ-Ⅳ度12例(12.50%)。96例接受移植的患者中复发10例,死亡38例,5年的总生存(OS)率为60.42%。Cox模型分析表明,aGVHD和移植前的疾病状态是影响患者长期生存率的主要因素,其相对危险度分别是2.996和2.619。结论:影响患者长期生存的主要危险因素是aGVHD和移植前的疾病状态,提高allo-HSCT疗效的关键是控制aGVHD,同时要把握好移植时机的选择,对于有高危复发因素的患者应争取在CR1期进行allo-HSCT。

The aim of this study was to analyze the risk factors for overall survival at 5 years in 96 patients undergoing allogeneic hematopoietic stem cell transplantation by retrospective analysis. 11 clinical parameters including age, sex, disease status, HLA locus, donor type, donor-recipient blood type, conditioning regimen, aGVHD, HC, VOD and IP were selected for univariate analysis by using a Cox regression. Factors have statistic significance at the 0. 1 level on univariate analysis were evaluated by multivariate analysis by a Coxs regression. The cumulative incidence of aGVHD and survival rate of patients were calculated by the method of Kaplan and Meier. The results showed that 95 patients achieved sustained donor engraftment except 1 patients. The median time of leukocyte engraftment （ANC ≥0.5×10^9/L） was 13 days. The aGVHD of Ⅰ-Ⅳ grade was observed in 42 out of 96 patients （43.75%）, in which 11 patients were with aGVHD of Ⅰgrade （ 11.46% ）, 19 patients were with aGVHD of Ⅱ grade （ 19.79% ）, 12 patients were with aGVHD of Ⅲ-Ⅳ grade （ 12.50% ）. Out of 96 patients 10 relapsed and 38 dead, the overall survival at 5 years was 60.42%. The Cox regression analysis showed that aGVHD and disease status before transplant were main factors affecting long-term survival of patients, relative risks of which were 2. 996 and 2. 619 respectively. It is concluded that the main factors affecting long-term survival of patients are aGVHD and disease status. The key to improve the outcome of allo-HSCT is to reduce the incidence and severity of aGVHD, meanwhile to select the CR1 for allo-HSCT to treat the patients in advanced refractory and relapsed situation should be considered as important risk factors.