造血干细胞移植共患病指数对异基因造血干细胞移植后非复发死亡率及总生存率的预测作用

Prognostic implications of hematopoietic cell transplantation-specific comorbidity index on non-relapse mortality and overall survival after aUogeneic hematopoietic stem cell transplantation

目的探讨造血干细胞移植共患病指数（HCT-CI）对异基因造血干细胞移植（allo-HSCT）患者移植后非复发死亡率（NRM）及总生存（OS）率的预测作用。方法选取2003年7月至2010年11月allo—HSCT患者161例纳入研究队列随访并总结临床资料，多因素分析HCT-CI、患者年龄、性别、预处理方案、移植前疾病状态、移植方式、HLA配型对NRM及OS率的影响。分析在不同移植前疾病状态下，HCT-CI评分对OS率及NRM的预测作用。结果161例allo-HSCT患者3年OS率及NRM分别为61．4％及26．4％。HCT-CI评分0分、1-2分及I〉3分组患者的3年NRM分别为14．9％、24．5％、52．7％，3年OS率分别为68．9％、64．6％、34．7％。组间比较显示，HCT-CI评分I〉3分和0分组患者的3年NRM及OS率差异有统计学意义（P值均〈0．01）。COX回归模型分析显示，移植前疾病状态高危、HCT-CI评分〉13为影响OS率及NRM的独立危险因素（相对危险度分别为3．53和3．35，3．77和6．85，P值均〈0．01）。在移植前疾病状态为低危的101例患者中，HCT-CI评分为0分、1-2分和I〉3分组患者的3年NRM及OS率差异有统计学意义（P值均〈0．01）；而在高危组的60例患者中，不同HCT-CI评分组间OS率及NRM的差异无统计学意义（P=0．252及0．347）。结论HCT-CI评分及移植前疾病状态分层是影响allo-HSCT后NRM和OS率的独立危险因素。在移植前疾病状态低危组，HCT-CI评分对allo-HSCT移植后的NRM及OS率具有预测作用；在移植前疾病状态高危组，HCT-CI评分对NRM及OS率无预测作用。

Objective To study the prognostic implications of hematopoietic cell transplantationspecific comorbidity index （HCT-CI） on non-relapse mortality （NRM） and overall survival （OS） in patients underwent allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Methods Clinical data of 161 cases received allo-HSCT from July 2003 to November 2010 were analyzed retrospectively. The prognostic significance of HCT-CI, age, sex, conditioning regimens, disease status before transplantation, graft source and the degree of HLA matches for NRM and OS was conducted by COX regression model. The prognostic impact of HCT-CI on NRM and OS was performed in all patients under different disease status before transplantation. Results Of the 161 cases with allo-HSCT, 3-year NRM and OS were 26.4% and 61.4% respectively. NRM at 3 years in patients with HCT-CI score 0, 1-2 and ≥3 were 14.9% , 24.5% and 52.7% respectively. And OS at 3 years were 68.9% , 64.6% and 34.7% respectively. There were significant differences between HCT-CI score 0 and≥3 groups for NRM and OS （P〈0.01）. High-risk disease status before transplantation （NRM： RR=3.35, P〈0.01; OS： RR=3.53, P〈 0.01） and HCT-CI score≥3 （NRM： RR=6.85, P〈0.01; OS： RR=3.77, P〈0.01） were independent risk factors by COX regression model. In the subgroup analysis according to disease status, high score of HCT- CI was associated with poor OS （P〈0.01） and high NRM （P〈0.01） in patients with low-risk, but not in those with high-risk disease status. Conclusions HCT-CI score and disease status before transplantation are independent risk factors for patients received allo-HSCT. HCT-CI score have prognostic implication for NRM and OS in patients with low-risk disease status, but not in high-risk group.