白血病患者异基因造血干细胞移植后早期淋巴细胞计数与预后的关系

The correlation between early lymphocyte count post-allogeneic hematopoietic stem cell transplanta- tion and prognosis in leukemia patients

目的分析白血病患者异基因造血干细胞移植（allo—HSCT）后早期淋巴细胞计数与移植预后的关系。方法收集2003年1月至2011年4月行allo—HSCT的124例白血病患者资料，回顾性分析移植后第30天淋巴细胞计数（1ymphocytecountonday30，LC30）与5年总生存（0s）率、5年复发率（RR）、5年非复发死亡（NRM）率、急性移植物抗宿主病（aGVHD）累积发生率及慢性移植物抗宿主病（cGVHD）累积发生率之间的关系。结果单因素分析提示，LC30≥0．40×10’／L患者和LC30〈0．40×10。／L患者相比，5年0s率明显升高[（62．2-4-5．8）％对（37．0±8．6）％，P=0．003]，5年RR明显降低[（13．9-4-4．7）％对（32．0-4-8．4）％，P=0．027]，5年NRM率明显降低[（31．3±5．8）％对（45．0±9．3）％，P=0．048]，cGVHD累积发生率明显升高[（82．9±4．6）％对（62．7±11．1）％，P=0．042]。多因素分析提示LC30与5年OS率、5年RR、5年NRM率、cGVHD累积发生率均相关，同时也发现移植前疾病危险分层与预后相关。结论allo—HSCT后早期淋巴细胞计数可作为白血病allo-HSCT后独市的预后指标．并可根据LC30{井行早期干预治疗。

Objective To analyze the correlation between early lymphocyte count （lymphocyte count on day 30, LC30） post-allogeneic hematopoietic stem cell transplantation（allo-HSCT） and transplant progno- sis in leukemia patients. Methods The data from 124 consecutive patients undergoing allo-HSCT for leuke- mia from January 2003 to April 2011 was analyzed retrospectively. LC30 post-allo-HSCT correlated with 5- year overall survival （OS） , 5-year relapse rate （RR） , 5-year nonrelapse mortality （ NRM ） , accumulative rate of acute graft versus host disease （aGVHD）and chronic graft versus host disease（cGVHD） was studied. Re- suits Univariate analysis indicated that patients with LC30≥0.40 x 109/L had higher 5-year OS than those with LC30 〈 0.40 x 109/L [ （62.2± 5.8 ） % vs （ 37.0 ± 8.6 ） %, P = 0. 003 ], lower 5-year RR [ （ 13.9 ± 4.7）% vs（32.0±8.4）%,P=0.0271, lower5-year NRM [（31.3 ＋5.8）% vs（45.0±9.3）%,P= 0. 048 ） ], and higher cGVHD cumulative incidence [ （ 82.9 ± 4.6 ） % vs （ 62.7 ± 11.1 ） %, P = 0. 042 ） ]. Multivariate analysis also suggested that LC30 was associated with 5-year OS, 5-year RR,5-year NRM, and cGVHD cumulative incidence. At the same time disease risk stratification was associated with prognosis. Conclusions Early lymphocyte count （LC30） post-allogeneic hematopoietic stem cell transplantation in leu- kemia is highly associated with prognosis, which can be the independent prognosis index after allo-HSCT in leukemia and can identify a group of patients who might be suitable candidates for early interventions treat- ment.