非血缘脐血移植后血小板植入延迟的高危因素及其对预后的影响

Risk factors and outcomes of delayed platelet engraftment after unrelated umbilical cord blood transplantation

目的研究非血缘脐血移植(UCBT)后血小板植入延迟(DPE)的高危因素及其对预后的影响。方法回顾性分析UCBT治疗恶性血液病的318例患者临床资料,据血小板植入时间分为血小板植入延迟(DPE)组(70例)和血小板植入正常(non-DPE)组(248例),非参数检验分析比较两组间血细胞植入特征,单因素及多因素分析血小板植入延迟的影响因素,并采用Cox回归分析血小板植入延迟对预后的影响。结果DPE发生率为22.01%。DPE组和non-DPE组的中位血小板植入时间分别为93(69,123)d和32(13,60)d,差异有统计学意义(P<0.001)。HLA等位基因不合(<6/8)、回输低CD34+细胞数(≤1.7×10^(5)/kg)、血小板植入前CMV感染及Ⅱ-Ⅳ度aGVHD是发生DPE的高危因素(P<0.0.5)。DPE组和non-DPE组的3年总生存率(OS)分别为32.9%和74.0%(P<0.001),无病生存率(DFS)分别为32.9%和68.1%(P<0.001),DPE、体质量>48 kg及Ⅲ-Ⅳ度aGVHD是影响生存率的危险因素(P<0.05)。结论DPE是UCBT后患者的独立危险因素,早期关注众多高危因素可预防DPE的发生,有利于对并发症做出及时处理。

Objective To investigate the risk factors and outcomes of delayed platelet engraftment(DPE)after unrelated umbilical cord blood transplantation(UCBT).Methods The clinical data of 318 patients with malignant hematological diseases treated by UCBT were retrospectively analyzed.According to the time of platelet engraftment,they were divided into the delayed platelet engraftment(DPE)group and the normal(non-DPE)group for further analysis Univariate and multivariate analysis were used to analyze risk factors of DPE.Coxregression analysis was used to analyze the effect of DPE on prognosis.Results The incidence of DPE after UCBT in all patients was 22.01%.The median time of platelet engraftment for the non-DPE and DPE groups were 93(69,123)days and 32(13,60)days.Allele-level HLA mismatch(<6/8),lower infused CD34+cell count(≤1.7×10^(5)/kg),CMV viremia and gradeⅡ-ⅣaGVHD preplatelet engraftment were high risk factors for DPE after UCBT.The probability of overall survival(OS)and disease free survival(DFS)at 3 years were 32.9%and 74.0%(P<0.001),32.9%vs.68.1%(P<0.001)in the DPE and non-DPE group.DPE,weight≥48 kg,andⅢ~Ⅳa GVHD are risk factors that affecting survival rate.Conclusion DPE after UCBT was associated with worse OS.Early identification of risk factors could be beneficial for the managements of complications.