血液病患者同基因造血干细胞移植后植入综合征的发生率及临床特征

Incidence and clinical characteristics of engraftment syndrome after syngeneic hematopoietic stem cell transplantation in patients with hematological diseases

目的探究血液病患者同基因造血干细胞移植(syn-HSCT)后植入综合征(ES)的发生率及其临床特征。方法纳入1994年1月至2018年5月在北京大学人民医院接受syn-HSCT的21例患者,对其临床资料进行回顾性分析。结果①21例患者中男13例,女8例,中位年龄24(4~46)岁。重型再生障碍性贫血2例,骨髓增生异常综合征1例,急性髓系白血病8例,急性淋巴细胞白血病6例,慢性髓性白血病4例。移植后中位随访时间为817(24~5602)d。②21例syn-HSCT患者中7例(33.3%)发生ES。首次出现ES相关症状的中位时间为移植后8(5~13)d,诊断ES的中位时间为移植后10(7~14)d。所有ES患者均以糖皮质激素治疗并获得完全缓解,中位症状持续时间为2(1~5)d。③多因素分析显示,原发病为急性髓系白血病(HR=15.298,95%CI 1.486~157.501,P=0.022)和中性粒细胞植入时间<12 d(HR=17.459,95%CI 1.776~171.687,P=0.014)是ES发生的独立危险因素。ES组与未发生ES组移植后总生存率与无病生存率差异无统计学意义。结论血液病患者syn-HSCT后具有较高的ES发生率,但预后较好。

Objective To explore the incidence and clinical characteristics of engraftment syndrome(ES)after syngeneic hematopoietic stem cell transplantation(syn-HSCT)in patients with hematological diseases.Methods The clinical data of 21 patients who received syn-HSCT at People’s Hospital of Peking University from January 1994 to May 2018 were retrospectively analyzed.Results Seven(33.3%)of 21 patients developed ES.The onset of ES symptoms occurred at a median of 8(range:5-13)days after HSCT,and the diagnosis of ES occurred at a median of 10(range:7–14)days after HSCT.Steroids were administered immediately after the diagnosis of ES,the median time of symptom continuance was 2(range:1–5)days,and all patients showed complete resolution of ES symptoms.In the multivariate analysis,patients with acute myeloid leukemia and faster neutrophil reconstitution were the risk factors for ES(HR=15.298,95%CI 1.486–157.501,P=0.022,and HR=17.459,95%CI 1.776–171.687,P=0.014).Meanwhile,there was no significant difference in the overall survival and disease-free survival between patients with ES and those without ES.Conclusion A high incidence of ES was observed in syn-HSCT recipients.Moreover,the prognosis of ES was excellent.