异基因造血干细胞移植治疗恶性血液病的预后分析

Prognostic analysis of allogeneic hematopoietic stem cell transplantation in treating patients with malignant hematological diseases

目的 探讨异基因造血干细胞移植（allo-HSCT）治疗恶性血液病的预后相关因素.方法 1997年7月至2008年8月,对26例血液病患者行allo-HSCT,其中急性白血病（AL）14例,慢性髓系白血病（CML）10例,骨髓增生异常综合征（MDS）2例;移植供受体22例为同胞HLA全相合,4例为同胞HLA不全相合.结果 所有患者达到稳定的供者植入,随访至今,累积总生存（OS）率为63.9%,累积无病生存（DFS）率为62.6%;15例（57.7%）发生移植物抗宿主病（GVHD）,其中急性GVHD 8例（30.8%）[Ⅲ-Ⅳ度4例（15.4%）],慢性GVHD 7例;HLA全相合与HLA不全相合移植间GVHD发生率差异有统计学意义（P=0.014）;复发4例;死亡7例.单因素分析结果显示,发生Ⅳ度GVHD、巨细胞病毒（CMV）感染是影响患者生存的高危因素,组问比较差异有统计学意义（P=0.05和P=0.027）.结论 allo-HSCT是目前治疗恶性血液病的有效方法,提高allo-HSCT疗效的关键是控制移植相关并发症,特别是GVHD和感染.

Objective To explore the clinical related prognostic factors of allogeneic hematopoietic stem cell transplantation （allo-HSCT） in treating malignant hematological diseases. Methods From September 1997 to August 2008,a total of 26 patients with hematological diseases were treated with allo-HSCT from HLA identical-sibling and haplo-identical donors in our hospital, including 14 patients with acute leukemias,10 with chronic myeloid leukemias,and 2 myelodysplastic syndromes. Results All patients achieved sustained full donor type engraftment. The cumulative overall survival （OS） was 63.9 %,and cumulative disease free survival （DFS） was 62.6 %. Fifteen patients had graft-versus-host disease （GVHD） （57.7 %）,including 8 acute GVHD（aGVHD） （30.8 %） （grade Ⅲ-Ⅳ aGVHD was 15.4 %） and 7 chronic GVHD. GVHD between HLA identical-sibling and haplo-identical donors was different and there was statistic difference between the two groups （P=0.014）. 4 patients relapsed,7 patients died. The univariate analysis showed OS were correlated with grade Ⅳ aGVHD （P=0.05） and CMV infection （P=0.027）. Conclusion Allo-HSCT is effective for the cure of patients with malignant hematological diseases. The key to improve the efficacy of HSCT is to reduce the incidence of transplant-related complications,especially GVHD and infection.