异基因造血干细胞移植术后继发性造血细胞减少的危险因素分析

Analysis of risk factors for secondary cytopenia after allogeneic hematopoietic stem cell transplantation

目的探讨异基因造血干细胞移植（allo—HSCT）后100天（＋100d）内继发眭造血细胞[白细胞和（或）血小板]减少的发生率及其危险因素。方法回顾性分析2006年1月1日至2008年1月1Et北京大学血液病研究所260例（包括单倍体相合160例和HLA全合100例）allo-HSCT患者的临床资料。根据移植后造血重建情况，将患者分为①继发性白细胞减少组；②继发性血小板减少组；③继发性植入功能不良组。分析各组患者的发生率及其危险因素。结果在＋100d内，单倍体相合移植组继发性白细胞减少（38．8％对18．0％，P=0．0005）和继发性血小板减少（25％对12％，P=0．01）的发生率均高于HLA全合移植组，两组间继发性植人功能不良（5．6％对2．0％）的发生率差异无统计学意义（P=0．21）。多因素分析显示，CMV感染是导致继发性白细胞减少的独立危险因素；移植物抗宿主病（GVHD）及CMV感染是导致继发性血小板减少的独立危险因素；CMV感染是导致继发性植入功能不良的独立危险因素。结论单倍体相合造血干细胞移植后继发性造血细胞减少较HLA全合移植更为常见，可能与单倍体相合造血干细胞移植后GVHD及CMV感染发生率较高有关。

Objective To investigate the incidence and risk factors for secondary cytopenia atter allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Methods The clinical data of a total of 260 patients received allo-HSCT between Jan 1, 2006 to Jan 1, 2008 were retrospectively analyzed for the incidence and risk factors of secondary cytopenia. According to the hematopoietic reconstitution after transplantation, the patients were divided into （1） secondary neutropenia group; （2） secondary thrombocytopenia group and （3）secondary poor graft function group. Results During the 100 days after allo-HSCT, the secondary neutropenia （38.8% vs 18.0%, P=0.0005） or secondary thrombocytopenia （25% vs 12%, P=0.01 ） occurred in haploidentical HSCT （haplo-HSCT） patients were more often than that in HLA-matched group. Poor graft function showed no significant difference between the above two groups （5.6% vs 2.0%, P=0.21）. Multivariate analyses revealed that cytomegalovirus （CMV） infection significantly increased the risk of secondary neutropenia. GVHD and CMV infection were independent risk factors for secondary thrombocytopenia. Meanwhile, CMV infection was an independent risk factor for secondary poor graft function. Conclusions Secondary cytopenia remains a serious complication following allo-HSCT, especially in haplo-HSCT. Higher occurrence of GVHD and CMV infection may lead to higher incidence of secondary cytopenia in haplo-HSCT.