疾病综合预后指数与异基因造血干细胞移植预后关系的研究

Research on the relationship between disease composite index and the prognosis of allogeneic hematopoietic stem cell transplantation

目的探讨结合恶性血液病病种、生物学特征和移植前疾病缓解状态的综合评分与异基因造血干细胞移植（allo—HSCT）预后的关系。方法回顾性分析上海交通大学医学院附属瑞金医院移植中心2007年1月至2012年2月间进行allo-HSCT的恶性血液病148例，按照疾病预后和移植前疾病缓解状态综合评分分为低危组（17例）、中危组（100例）、高危组（31例）三组，分别比较总体生存率、无事件生存率、复发率和移植相关死亡率。结果低、中、高危组患者总体生存率分别为76．5％、66．0％、41．9％（P=0．002），无事件生存率分别为70．6％、57．0％、32．3％（P=0．001），复发率分别为5．9％、27．1％、41．9％（P〈0．001），移植相关死亡率分别为23．5％、17．2％、29．0％（P=0．190）。多因素分析显示疾病综合预后指数与总体生存率、无事件生存率及复发率均相关（P=0．005，P=0．001，P〈0．001），与移植相关死亡率无关（P=0．666），同时疾病综合预后指数是影响allo-HSCT复发率的独立预后指标。结论结合恶性血液病预后及移植前疾病缓解状态的综合评分与allo—HSCT复发率密切相关。

Objective To assess the impact of a composite index which combines the prognosis of specific hematologic malignancies and the disease remission state pre-transplant on the efficacy of allogeneic hematopoietic stem cell transplantation. Methods A total of 148 patients who underwent allogeneic hematopoietic stem cell transplantation from Jan, 2007 to Feb, 2012 in the Blood and Marrow Transplantation Center of Ruijin Hospital were included in this retrospective analysis. According to the composite score, patients were classified into low-risk group （n = 17）, medium-risk group （n = 100） and high-risk group （n = 31）. The overall survival （OS）, event free survival （EFS）, treatment related mortality （TRM） and relapse rate （RR） were analyzed. Results Significant difference had been found on OS （76.5 % vs 66.0 % vs 41.9 %, P = 0.002）, EFS （70.6 % vs 57.0 % vs 32.3 %, P = 0.001） and RR （41.9 % vs 27.0 % vs 5.9 %, P 〈 0.001） among the three groups. However, there was no impact on treatment related mortality （23.5 %, 17.0 %, 29.0 %, P = 0.190）. Multivariate analysis suggested that the composite index affecting the OS, EFS and RR of allogeneic hematopoietic stem cell transplantation （P = 0.005, P = 0.001, P 〈 0.001）, but not the TRM （P = 0.666）. To some extent, it was an independent prognosis index on RR. Conclusion The composite index is closely related to the efficacy of allogeneic hematopoietic stem cell transplantation.