单倍型相合造血干细胞移植治疗恶性血液病与人类白细胞抗原相合同胞移植疗效相当

Haploidentical hematopoietic stem cell transplantation for hematologic malignancies is equivalent to HLA matched sibling transplantation

目的对单倍型相合造血干细胞移植(Haplo-SCT)及人类白细胞抗原相合同胞造血干细胞移植(human leukocyte antigen matched sibling donor transplantation,MSDT)治疗恶性血液病进行临床观察,对比分析两者疗效。方法回顾性分析2012年7月至2016年12月在我院接受异基因造血干细胞移植的恶性血液病患者58例,HaploSCT组33例,同期MSDT组25例,分析影响移植后生存的相关危险因素。结果 (1)Haplo-SCT组与MSDT组移植后均获得造血重建。(2)两组Ⅱ~Ⅳ度急性移植物抗宿主病(acute graft versus host disease,aGVHD)的累积发生率分别为33.3%和24%(P=0.261),Ⅲ~Ⅳ度aGVHD累积发生率分别为18.2%和8%(P=0.611)。(3)两组1年无白血病生存(leukemia-free survival,LFS)率分别为77%和61%(P=0.211),2年总生存(overall survival,OS)率分别为72%和61%(P=0.118)。(4)多因素分析显示移植后复发是影响OS的危险因素。结论对于缺乏HLA相合同胞供者的恶性血液病患者而言,单倍型相合供者是可供选择的干细胞来源。

Objective To compare the clinical efficacy for treatment of malignant hematological disease in haploidentical hematopoietic stem cell transplantation（Haplo-SCT）and human leukocyte antigen identical sibling hematopoietic stem cell transplantation（human leukocyte antigen matched sibling donor transplantation,MSDT）.Methods Fifty-eight patients with hematologic malignancies undergoing related haploidentical（n =33）and HLAidentical sibling（n =25）in our hospital were enrolled for a retrospective analysis.The clinical efficacy and related risk factors of post transplantation overall survival（OS）were analyzed.The therapeutic effects of the two treatments and the risk factors related to overall survival（OS）were evaluated.Results（1）Haploidentical and identical sibling cohorts were successfully engrafted.（2）The cumulative incidences of gradesⅡtoⅣ acute graft-versus-host disease（aGVHD）and gradesⅢtoⅣ aGVHD in the mismatched and matched cohorts were 33.3% versus 24%（P =0.261）and 18.2%versus 8%（P =0.611）,respectively.（3）One-year leukemia-free survival（LFS）and two-year OS in mismatched and matched cohorts were 77% vs 61%（P =0.211）and 72% vs 61%（P =0.118）,respectively.（4）Multivariate analysis showed that only relapse after allo-HSCT（P =0.033）were risk factors for OS.Conclusion For patients with hematological malignancies lacking matched sibling donor,HLA-haploidentical donors were an alternative stem cell source.