造血干细胞移植综合风险指数对血液系统恶性肿瘤患者异基因造血干细胞移植预后的预测作用

The prognostic implications of hematopoietic cell transplant composite risk for the patients with malignant hematopoietic diseases underwent allogeneic hematopoietic stem cell transplantation

目的:探讨造血干细胞移植综合风险(hematopoietic cell transplant composite risk,HCT-CR)指数对于血液系统恶性肿瘤患者接受异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)后总生存(overall survival,OS)、无进展生存(progress free survival,PFS)、无移植物抗宿主病(graft versus host disease,GVHD)并无复发生存(GVHD relapse free survival,GRFS)以及非复发死亡(non-relapse mortality,NRM)的预测作用。方法:选取我科2018年1月至2019年12月接受allo-HSCT的血液系统恶性肿瘤患者67例纳入研究队列随访并总结临床资料,多因素分析患者性别、供者类型以及HCT-CR指数对OS、PFS、GRFS及NRM率的预测作用。结果:67例患者1年总体OS、PFS、GRFS及NRM率分别为73.6%、69.6%、57.9%及18.3%。组间比较显示,HCT-CR评分低危组与高危组患者移植后1年OS、PFS及NRM率差异均有统计学意义(P值分别为0.007、0.021及0.026),而GRFS率差异无统计学意义(P=0.257)。Cox回归模型多因素分析示HCT-CR评分影响患者OS率与PFS率(P值分别为0.016、0.031),对于NRM率、GRFS率无影响(分别P=0.05、P=0.245),移植供者类型影响患者OS、PFS及GRFS率(P值分别为0.021、0.028及0.036),对于NRM率无作用(P=0.062),患者性别对于移植后OS、PFS、GRFS及NRM率均未见明显影响(P值分别为0.646、0.590、0.181及0.879)。结论:HCT-CR可以对血液恶性肿瘤患者接受allo-HSCT的预后做出预测,GVHD相关指标有待加入以提升其预测GRFS功能。

Objective To evaluate the prognostic implications of hematopoietic cell transplant composite risk(HCTCR)for the patients with malignant hematopoietic disease underwent allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods The clinical data of 67 patients with malignant hematopoietic diseases receiving allo-HSCT from Jan 2018 to Dec 2019 were analyzed retrospectively.The prognostic impact of HCT-CR on overall survival(OS),progress free survival(PFS),graft-versus-host disease and relapse-free survival(GRFS)and non-relapse mortality(NRM)was observed in all patients.The prognostic significance of HCT-CR,sex and donor type for OS,PFS,GRFS and NRM was conducted by Cox regression model.Results In the 67 cases,1-year OS,PFS,GRFS and NRM were 73.6%,69.6%,57.9%and 18.3%,respectively.There were significant differences between HCT-CR low risk and high risk groups for 1-year OS,PFS and NRM(P values were 0.007,0.021 and 0.026,respectively),while there was no significant difference for GRFS(P=0.257).By Cox regression model,HCT-CR was an independent factor for OS and PFS,while it didn't show relationship with NRM or GRFS(P=0.05,P=0.245).Donor type showed influence on OS,PFS and GRFS(P values were 0.021,0.028 and 0.036,respectively),but it had no effect on NRM(P=0.062).Sex of patients didn't show influence on OS,PFS,GRFS or NRM(P values were 0.646,0.590,0.181 and 0.879,respectively).Conclusions The HCT-CR score has good prognostic implications for OS,PFS and NRM for the malignant hematopoietic patients receiving allo-HSCT,while adding GVHD related indexes may improve the prediction for GRFS.