造血干细胞移植受者慢性疾病状态及相关因素研究

Study on chronic health conditions and its related risk factors in recipients after hematopoietic stem cell transplantation

目的回顾性研究接受造血干细胞移植后获得长期生存受者的慢性疾病状态；对自体移植与异基因移植、异基因移植亲缘供者中HLA全相合与HLA不全相合组受者的慢性疾病状态分别进行比较研究。方法对接受造血干细胞移植且生存1年以上的101例受者，采用骨髓移植生存研究自评量表[BoneMarrowTransplantSurvivorStudy（BMTSS）questionnaire]进行研究，将所得数据进行统计学分析。结果造血干细胞移植获得长期生存的受者约48．5％继发1种或以上慢性并发症，其中83．7％为轻中度；异基因移植患者总得分为3分及以上的比例（32．1％）比自体移植患者（10．O％）高；亲缘HLA全相合移植受者总得分为1—2分、3—4分、≥5分者比例分别为23．5％、29．4％、14．7％，明显高于HLA不全相合移植受者（15．6％、15．6％、6．2％），慢性疾病状态多与慢性移植物抗宿主病相关；单因素分析显示，亲缘异基因造血干细胞移植的患者年龄、HLA全相合、预处理方案中包含抗胸腺细胞球蛋白（ATG）可影响移植后慢性疾病状态的发生。多因素分析发现移植时年龄为影响移植受者慢性疾病状态的唯一独立危险因素。结论造血干细胞移植存活1年以上的受者其慢性疾病状态多为轻中度；亲缘HLA全相合移植受者慢性疾病状态较HLA不全相合移植受者严重。移植时年龄为影响亲缘异基因移植受者慢性疾病状态的独立危险因素。

Objective To study the chronic health conditions（ CHC ） in long-term survival recipient after hematopoietic stem cell transplantation （HSCT）. Methods The CHC of 101 cases survived for more than 1 year after HSCT were collected according to Bone Marrow Transplant Survivor Study（MBMTSS） ques- tionnaire. The differences of the incidence and severity of CHC between auto-HSCT and allo-HSCT, HLA- matched and HLA-mismatched family donors HSCT were compared, and risk factors related to chronic health conditions were analysized retrospectively in family donor HSCT. Results Of the 101 HSCT survivors, 48. 5% reported one or more chronic health conditions, and 83.7% of which were mild to moderate. The CHC in HLA-matched related donors HSCT were more serious than in HLA-mismatehed related donors HSCT. The percentage of CHC total score above 3 in allo-HSCT recipients （32.1% ） was higher than that in auto-HSCT ones（ 10.0% ）. The percentage of CHC total score 1 -2, 3 -4, and above 5 in HLA-matched family donors HSCT were 23.5%, 29.4% , and 14.7% , respectively, being significantly higher than those in HLA-mis- matched ones（ 15.6% , 15.6% , and 6.2% , respectively）. CHC was mainly related to chronic graft-versus- host disease（eGVHD）. Single variable analysis showed that younger age at time of transplantation, HLA fully matched, the use of antithymocyte globulin （ATG） in the conditioning regimens were favorable for CHC. COX-regression Model showed that age was the only independent risk factor for predicting the CHC in family donor HSCT. Conclusion The chronic health conditions after HSCT is mild to moderate, these complica- tions in HLA-matched related donor HSCT are more serious than those in HLA-mismatched related donor HSCT. The age at transplantation is the only independent risk factor for chronic health conditions.