造血干细胞移植后硬皮病样慢性移植物抗宿主病的临床表现

Sclerodermatous chronic graft-versus-host disease after hematopoietic stem cell transplantation: incidence, clinical characteristics and risk factors

目的探讨异基因造血干细胞移植（allo-HSCT）后硬皮病样慢性移植物抗宿主病（Sc GVHD）的发病率、危险因素。方法对我院2012年1月～2014年12月之间进行allo-HSCT的259例患者发生Sc GVHD的情况进行回顾性分析。结果 134例（51.7%）发生慢性移植物抗宿主病（c GVHD）,其中22例为硬皮病型,即Sc GVHD在移植患者中的发病率为8.49%（22/259）、在c GVHD患者中的发病率为16.4%（22/134）。Sc GVHD出现的中位时间为移植后12.5（4～28）月。单因素分析结果提示预处理方案是否含全身照射（TBI）（P=0.031）、GVHD预防方案是否含霉酚酸酯（MMF）（P=0.046）、c GVHD（P=0.008）的发生、供者淋巴细胞回输（DLI）（P=0.001）均与Sc GVHD的发生具有相关性。多因素分析确定c GVHD[相对危险度（RR）=3.512,95%可信区间（CI）=1.235～9.987,P=0.018]和DLI（RR=5.217,95%CI=1.698～16.029,P=0.004）为Sc GVHD发病的独立危险因素。结论Sc GVHD是移植后一种较为少见的并发症,移植物抗宿主病（GVHD）和DLI是其发病的独立危险因素。

Objective To investigate the incidence and risk factors of sclerodermatous chronic graft- versus- host disease（Sc GVHD） after allogeneic hematopoietic stem cell transplantation（allo- HSCT）. Methods The clinical data of 259 patients undergoing allo- HSCT in Nanfang Hospital between January, 2012 and December, 2014 were analyzed. Results Chronic GVHD following allo- HSCT occurred in 134（51.7%） cases, among whom 22 patients showed sclerodermatous features at a median of 12.5 months（range 4-28 months） after the transplantation. The overall incidence of Sc GVHD was 8.49%（22/259） in the recipients and 16.4%（22/134） in those with c GVHD. Univariate analysis showed that the conditioning regimen with total body irradiation（P=0.031）, GVHD prophylaxis with MMF（P=0.046）, presence of chronic GVHD（P=0.008）, and donor lymphocyte infusion（P=0.001） were all closely associated with the occurrence of Sc GVHD. Multivariate analysis identified chronic GVHD（RR=3.512, 95% CI： 1.235- 9.987, P=0.018） and donor lymphocyte infusion（RR=5.217, 95% CI： 1.698- 16.029, P=0.004） as the independent risk factors of Sc GVHD. Conclusion Sc GVHD following allo-HSCT is not a common complication,and c GVHD and donor lymphocyte infusion are the independent risk factors for Sc GVHD.