非肝炎相关重型再生障碍性贫血受者移植前铁过载对allo-HSCT疗效的影响

Effect of pre-transplantation iron overload on the outcomes of allogeneic hematopoietic stem cell transplantation patients with non-hepatitis-related severe aplastic anemia

目的探讨非肝炎相关性重型再生障碍性贫血(SAA)受者异基因造血干细胞移植(allo-HSCT)前铁过载对移植疗效的影响。方法回顾性分析2012年7月至2018年7月底接受allo-HSCT的98例非肝炎相关性SAA受者的临床资料。取移植前2个月内血清标本,测定血清铁蛋白(SF)。根据移植前SF水平将受者分为铁过载组和对照组,研究铁过载对allo-HSCT后总体存活(OS)率、造血重建及各种常见并发症发生率的影响。结果98例非肝炎相关性SAA受者,移植前SF中位数值为798.7 ng/ml(52.0~11 060.0 ng/ml)。根据SF水平分组,铁过载组(SF>800.0 ng/ml)、对照组(SF<800.0 ng/ml)各49例(50 %)。铁过载组受者allo-HSCT后早期CMV血症发生率增高(P=0.041),中性粒细胞、血小板重建时间延迟,差异有统计学意义(P值分别为0.001、0.005);供受者血型相合的受者中,铁过载组受者allo-HSCT后脱离输注红细胞时间延迟,差异有统计学意义(P=0.043)。铁过载组受者3年OS率(65.1±7.1)%,对照组受者3年OS率(93.3±3.7)%,两组差异有统计学意义(P=0.001)。多因素分析显示,3年OS率与移植前铁过载(P=0.022)、供受者血型(P=0.015)及allo-HSCT后早期菌血症(P=0.003)、CMV血症(P=0.003)显著相关。结论移植前铁过载受者allo-HSCT后OS率显著下降、CMV血症发生率显著增加及造血重建延迟。

Objective To explore the effect of iron overload on the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients with non-hepatitis related severe aplastic anemia (SAA). Methods The clinical data were retrospectively analyzed for 98 patients with non-hepatitis related SAA undergoing allo-HSCT from July 2012 to late July 2018 at a single center. Serum ferritin (SF) was measured within 2 months before HSCT. They were divided into iron overload (SF>800.0 ng/ml, n=49) and control (SF<800.0 ng/ml, n=49) groups according to SF level. Overall survival (OS), hematopoietic reconstitution and common complications after allo-HSCT were analyzed. Results The median pre-transplantation SF value was 798.7(52.0-11060.0l) ng/ml. Patients with pre-transplantation iron overload had a higher incidence of cytomegaloviremia (P=0.041), delayed recovery of neutrophil/platelet (P=0.001, P=0.005 respectively) and transfusion-dependence in donor-recipient blood group-matched patients (P=0.043) after allo-HSCT. The 3-year OS was (65.1±7.1)% in iron overload group and (93.3±3.7)% in control group (P=0.001). Multivariate analysis indicated that 3-year OS was independently correlated with pre-transplantation iron overload (P=0.022), blood group of donor & recipient (P=0.015), early bacteremia (P=0.003) and cytomegaloviremia (P=0.003). Conclusions Iron overload is common in patients with non-hepatitis-related SAA before transplantation. Pre-transplantation iron overload has a significant impact on OS, hematopoietic reconstitution and cytomegaloviremia after allo-HSCT.