联合第三方脐血输注的单倍体HSCT后慢性移植物抗宿主病的临床分析

The clinical study of chronic graft-versus-host disease followinghaploidentical transplantation combined infusion with a third party cord blood

目的:探讨联合第三方脐血输注的单倍体造血干细胞移植(haplo-cord-HSCT)后,合并慢性移植物抗宿主病(cGVHD)的临床特征及影响生存的危险因素。方法:回顾性总结2011年1月至2016年7月期间300例haplo-cord-HSCT受者的临床资料。300例受者中,男性189例,女性111例,中位年龄25岁(2~55岁);cGVHD评估标准采用2014年美国国立卫生研究院(NIH)共识,多因素分析采用logistic、COX回归。结果:自造血干细胞移植开始随访,发生cGVHD受者共73例,发生率为24.3 %,中位发生时间为移植后180 d(90~1200 d);移植后1、3、5年cGVHD累积发生率为26.3 %(95 %CI:23.5 %~29.1 %)、30.3 %(95 %CI:27.3 %~33.3 %)和32.2 %(95 %CI:28.7 %~35.7 %)。所有cGVHD患者给予一线或二线治疗,截至随访日期,53例存活,20例死亡。多因素分析结果显示,血小板数量<100×10 9/L(HR=0.103,95 %CI:3 %~36.1 %,P<0.001)是影响haplo-cord-HSCT后GVHD受者总体存活率(GOS)的独立危险因素。 结论:haplo-cord-HSCT后5年的cGVHD累积发生率较高(32.2 %);血小板数量<100×10 9/L是影响cGVHD受者存活的独立危险因素。

Objective To investigate the incidence,risk factors and survival of cGVHD patients in combination of a haploidentical donor supported with an unrelated umbilical cord blood for hematopoietic stem cells transplantation(haplo-cord-HSCT).Methods 300 hematological malignancies individuals who received dual transplantation were enrolled in the study between January 2012 and July 2016 at the department of Hematology in the First Affiliated Hospital of Soochow University.The clinical diagnosis and scoring the severity of cGVHD syndromes according the National Institutes of Health(NIH)consensus conference in the 2014 update.Cox proportional hazards regression was used to identify risk factors associated with transplant outcomes.Results During follow-up with a median time of 26.4 months(range 0.2-61.8)post transplantation,the 1-year,3-year and 5-year cumulative incidence of cGVHD was 26.3%(95%confidence interval[CI],23.5%~29.1%),30.3%(95%CI,27.3%~33.3%)and 32.2%(95%CI,28.7%~35.7%).For all 73 patients with cGVHD,first-line or second-line treatment were given.During the follow-up period,53 patients survived,and 20 patients died.In multivariate analysis,the cGVHD overall survival(GOS)were associated with thrombocytopenia(<100×109/L)(HR=0.103,95%CI 3%-36.1%,P<0.001).Conclusions Our data suggest that,the 5-year cumulative incidence of cGVHD was 32.2%after haplo-cord-HSCT with hematological malignancies.Thrombocytopenia(<100×109/L)was independent risk factors for GOS.