血液病患者抗人类白细胞抗原抗体与同胞全相合造血干细胞移植预后的关系

Correlation between anti-human leukocyte antigen antibodies and the outcomes of matched sibling donor transplantation in patients with hematological diseases

目的探讨接受抗人类白细胞抗原(HLA)同胞全相合造血干细胞移植(MSDT)的血液病患者体内存在的抗HLA抗体与移植预后的关系。方法收集2015年3月至2017年11月于北京大学人民医院行MSDT的168例血液病患者,在移植前检测其体内是否存在抗HLA抗体,分析抗HLA抗体与移植后造血细胞植入、血制品输注及预后的关系。结果168例患者中,抗HLAⅠ或Ⅱ类抗体阳性患者28例(16.7%),抗HLAⅠ和Ⅱ类抗体同时阳性患者14例(8.3%);所有患者均获得中性粒细胞植入,164例(97.9%)患者获得血小板植入。单因素分析结果显示,抗HLA抗体对移植后粒细胞植入及植入时间、血小板植入及植入时间、红细胞输注量、血小板输注量、总生存(OS)、无病生存(DFS)以及移植相关死亡率(TRM)均无影响(均P>0.05)。多因素分析结果显示,血小板植入与更好的OS(HR=0.065,95%CI 0.017~0.252,P<0.01)和DFS(HR=0.083,95%CI 0.024~0.289,P<0.01)以及更低的TRM(HR=0.094,95%CI 0.014~0.626,P=0.015)相关。结论接受MSDT的血液病患者体内的抗HLA抗体对移植预后无影响。

Objective To explore the relationship between anti-human leukocyte antigen(HLA)antibodies and transplant outcomes in patients with hematological diseases who underwent matched sibling donor transplantation(MSDT).Methods A retrospective analysis was conducted in 168 patients with hematological diseases who received MSDT in Peking University People's Hospital from March 2015 to November 2017.All patients received detection of anti-HLA antibodies before transplantation,and the correlation between anti-HLA antibodies and transplant outcomes such as hematopoietic cells implantation,blood product transfusion and prognosis after transplantation were analyzed.Results Among the 168 patients,28(16.7%)were positive for anti-HLA classⅠor classⅡantibodies,and 14(8.3%)were positive for both anti-HLA classⅠand classⅡantibodies.All patients received neutrophil engraftment,164 patients(97.9%)received platelet engraftment.Univariate analysis showed that there were no effects of anti-HLA antibodies on neutrophil engraftment and engraftment time,platelet engraftment and engraftment time,the volume of red cell transfusion,the volume of platelet transfusion,overall survival(OS)rate,disease free survival(DFS)rate and transplant-related mortality(TRM)in patients with hematological diseases underwent MSDT(all P>0.05).Multivariate analysis showed that platelet engraftment was associated with better OS(HR=0.065,95%CI 0.017-0.252,P<0.01),better DFS(HR=0.083,95%CI 0.024-0.289,P<0.01)and lower TRM(HR=0.094,95%CI 0.014-0.626,P=0.015).Conclusion Anti-HLA antibodies have no effect on transplant outcomes of patients with hematological diseases who have received MSDT.