异基因造血干细胞移植后嵌合状态与白血病复发关系的研究

Relationship analysis between chimerism and relapse of leukemia after allogeneic hematopoietic stem cell transplantation

目的探讨异基因造血干细胞移植(allo-HSCT)后嵌合状态与白血病复发的关系。方法回顾性分析2014年1月至2018年6月于我院行清髓性allo-HSCT的成人白血病患者73例,采用短串联重复序列-聚合酶链反应(STR-PCR)检测移植后+30、+60、+90天受者骨髓的供受者细胞嵌合率,分析嵌合率与复发的关系。结果移植后+90天复发组嵌合率低于非复发组。移植后+60 d、+90 d低嵌合患者有较高的复发率(P=0.021,0.027)。多因素分析显示移植前疾病状态、+60d嵌合率、+90d嵌合率是白血病患者行allo-HSCT后复发的独立危险因素。结论Allo-HSCT后嵌合状态对复发具有预测价值,+60、+90天低嵌合患者有较高的复发率。

Objective To investigate the relationship between chimerism and leukemia relapse after allogeneic hematopoietic stem cell transplantation(allo HSCT).Methods Totally 73 adults with leukemia undergoing myeloablative allo HSCT from January 2014 to June 2018 were retrospectively analyzed.Polymerase chain reaction amplification of short tandem repeat sequence(STRPCR)was used to detect donor cell chimerism rates of recipient bone morrow after+30 d,+60 d,+90 d of transplantation.Then the relationship between chimerism and the relapse was analyzed.Results Thechimerism rate of the relapse group was lower than that of non-relapsegroup after+90 d of transplantation.Patients with low chimerism had higher relapse rate after+60 d and+90 d of transplantation(P=0.021,0.027,respectively).Multivariate analysis showed that leukemia status before transplantation,donor cell chimerismrate after+60 days of transplantation,donor cell chimerismrate after+90 days of transplantation were the risk factors of relapse after patients undergoing allo HSCT.Conclusion The study indicated that chimerismrate has predictive value for leukemia recurrence afterallo HSCT.And the recurrence rate of patients with low chimerism after+60 d and+90 d of transplantation is high.