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影响造血干细胞移植的骨髓增生异常综合征患者生存期的因素分析 被引量:3

Analysis of Factors Influencing Overall Survival of MDS Patients Transplanted with HSCs
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摘要 目的:分析进行造血干细胞移植的骨髓增生异常综合征(myelodysplastic syndrome,MDS)患者的临床特点、常规实验室检查及相关基因突变对总生存期(overall survival,OS)的影响。方法:选取并回顾性分析2013年10月至2018年8月在苏州大学附属第一医院诊断MDS并进行造血干细胞移植(hematopoietic stem cell transplantation,HSCT)的患者121例,收集患者基本信息,并检测患者血细胞、初诊骨髓原始细胞、染色体核型及基因突变情况。用统计学方法分析不同因素对生存期的影响。结果:Kaplan-Meier单因素分析发现,不同年龄段之间OS有明显差异,患者年龄越高,3年OS率越低,0-29岁患者3年OS率为(83.3±7.7)%;30-49岁患者3年OS率为(58.1±7.7)%;50-69岁患者均3年OS率为(31.0±22.6)%,且各组之间OS率统计学差异显著(P<0.05)。不同移植类型对患者OS也有显著影响,3年OS率:同胞全相合HSCT>非血缘全相合HSCT>单倍体相合HSCT>微移植。骨髓原始细胞≥10%的患者OS率低于<10%的患者,但差异没有统计学意义。染色体核型复杂异常患者3年OS率为(47.7±11.5)%,非复杂异常患者的3年OS率为(80±4.2)%(P<0.05)。DNMT3A、NRAS、TP53、GATA2基因非突变患者比基因突变的患者移植后OS期长,差异有统计学意义(P<0.05)。COX多因素分析结果显示,年龄、染色体核型、DNMT3A、TET2、GATA2、NRAS对MDS移植后OS有独立影响,且差异具有统计学意义。结论:患者年龄,造血干细胞移植供体选择,患者初诊染色体核型,DNMT3A、NRAS、TP53、GATA2、TET2基因突变均是影响MDS移植后生存期的独立因素。因此对MDS移植患者生存期的评估需要综合多方面考虑。 Objective:To analyze the effect of clinical features,routine laboratory examination and related gene mutation on the OS of patients with myelodysplastic syndrome(MDS)after hematopoietic stem cell transplantation(HSCT).Methods:121 patients diagnosed as MDS and underwent hematopoietic stem cell transplantation in the First Affiliated Hospital of Soochow University from October 2013 to August 2018 were selected.Basic information of the patients was collected,and blood cells,bone marrow blasts at initial diagnosis,chromosomal karyotypes and gene mutations of the patients were detected.The effect of different factors on overall survival(OS)was analyzed by statistical method.Results:Kaplan-Meier univariate analysis shows that OS was significanly different among different age groups.The 3-year OS rate of patients aged 0-29 years was(83.3±7.7)%,the 3-year OS rate in patients aged 30-49 years was(58.1±7.7%),and the 3-year OS rate of patients aged 50-69 years was(31.0±22.6)%,which was statistically different(P<0.05)between different groups.There were also significant differences in OS among patients with different transplantation types.3-year OS rate:HLA-matched sibling HSCT>unrelated HLA-matched HSCT>haploidentical HSCT>micro HSCT.The OS rate of patients with bone marrow blasts≥10%seems lower than blasts<10%,but there was no statistical difference.The 3-year OS rate of patients with chromosomal karyotype complex abnormality was(47.7±11.5)%,and that of patients without complex abnormality was(80±4.2)%which was statistical difference(P<0.05).Patients with DNMT3A,NRAS,TP53 and GATA2 mutations had shorter OS time compared with patients without mutation of these genes,which shows statistically significant(P<0.05).COX multivariate analysis showed that age,chromosome karyotype,DNMT3A,TET2,GATA2 and NRAS were the independent factors influencing OS of patients after HSCT,with statistically significant difference.Conclusion:age of patients,donor selection of HSCT,chromosome karyotype,DNMT3A,NRAS,TP53,GATA2 and TET2 gene mutations are all independent factors affecting the OS of patients after HSCT.Therefore,the assessment of the OS of MDS patients with transplantation requires comprehensive consideration.
作者 蒋煜新 张灵 陈子兴 岑建农 陈苏宁 祁小飞 邱桥成 王元元 JIANG Yu-Xin;ZHANG Ling;CHEN Zi-Xing;CEN Jian-Nong;CHEN Su-Ning;QI Xiao-Fei;QIU Qiao-Cheng;WANG Yuan-Yuan(The First Affiliated Hospital of Soochow University Jiangsu Institute of Hematology,Key Laboratory of Thrombosis and Hemostasis of Ministry of Health,Collaborative Innovation Center of Hematology,Suzhou 215006,Jiangsu Province,China)
出处 《中国实验血液学杂志》 CAS CSCD 北大核心 2020年第4期1283-1291,共9页 Journal of Experimental Hematology
基金 国家自然科学基金(81070402、81070416) 江苏省科教兴卫工程-临床医学中心资助(ZX201102)。
关键词 骨髓增生异常综合征 实验室检查 基因突变 造血干细胞移植 总生存期 myelodysplastic syndrome laboratory examination gene mutation hematopoietic stem cell transplantation overall survival
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