异基因造血干细胞移植后植入功能不良的危险因素分析

Risk factors of poor graft function after allogeneic hematopoietic stem cell transplantation

目的探讨异基因造血干细胞移植(allo-HSCT)后植入功能不良(PGF)的危险因素。方法对2014年1月至2021年12月贵州医科大学附属医院333例行allo-HSCT的患者进行回顾性分析,将患者分为PGF组(n=32)和植入功能良好(GGF)组(n=301),通过单因素分析和logistic回归分析确定PGF可能的影响因素,并采用Kaplan-Meier生存分析对比两组患者的生存差异。结果原发疾病为急性髓系白血病(AML)、急性淋巴细胞白血病(ALL)、骨髓增生异常综合征(MDS)、重型再生障碍性贫血(SAA)及其他的患者PGF发生率分别为6.94%、3.96%、14.28%、26.23%、0,差异有统计学意义(χ^(2)=26.021,P<0.001),SAA患者PGF发生率最高。单因素logistic回归分析表明SAA患者与AML、ALL、MDS及其他患者相比,移植后更易发生PGF(OR=1.514,95%CI:1.158~1.980,P=0.002)。多因素logistic回归分析结果表明,单倍体相合移植(OR=2.585,95%CI:1.163~5.742,P=0.020)、输注CD34^(+)细胞数≤5×10^(6)/L(OR=2.330,95%CI:1.058~5.132,P=0.036)、巨细胞病毒(CMV)感染(CMV-DNA>500 copies/mL,OR=2.933,95%CI:1.292~5.623,P=0.010)是PGF的独立危险因素。Kaplan-Meier生存曲线显示,PGF组3年总生存率、3年无进展生存率均明显低于GGF组(37.5%vs.47.8%、25.0%vs.36.8%,P<0.05)。结论单倍体相合移植、输注CD34^(+)细胞数低(≤5×10^(6)/kg)、CMV感染与PGF的发生密切相关,SAA也是PGF的危险因素,SAA患者较AML、ALL、MDS患者移植后更易出现PGF。

Objective To investigate the risk factors of poor graft function(PGF)after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods A total of 333 patients who underwent allo-HSCT from January 2014 to December 2021 in the Affiliated Hospital of Guizhou Medical University were retrospectively analyzed and divided into the PGF group(n=32)and good graft function(GGF)group(n=301).Univariate analysis and logistic regression analysis were used to determine the possible influencing factors of PGF,and the survival difference between the two groups was compared by using Kaplan-Meier survival analysis.Results The incidence of PGF in patients with primary diseases such as acute myeloid leukemia(AML),acute lymphoblastic leukemia(ALL),myelodysplastic syndrome(MDS),severe aplastic anemia(SAA)and others was 6.94%,3.96%,14.28%,26.23% and 0,respectively,the difference was statistically significant(χ^(2)=26.021,P<0.001),and the incidence of PGF was the highest in patients with SAA.The results of univariate logistic regression analysis showed that SAA patients were more likely to develop PGF after transplantation compared with AML,ALL,MDS,and other patients(OR=1.514,95%CI:1.158-1.980,P=0.002).The results of multivariate logistic regression analysis showed that haploidentical transplantation(OR=2.585,95%CI:1.163-5.742,P=0.020),infusion of CD34^(+)cell count≤5×10^(6)/kg(OR=2.330,95%CI:1.058-5.132,P=0.036)and cytomegalovirus(CMV)infection(CMV-DNA>500 copies/mL,OR=2.933,95%CI:1.292-5.623,P=0.010)were the independent risk factors for PGF.Kaplan-Meier survival curve showed that the 3-year overall survival and 3-year progression-free survival rates of the PGF group were lower than those in the GGF group(37.5%vs.47.8%,25.0%vs.36.8%,P<0.05).Conclusion Haploidentical transplantation,low number of infused CD34+cells(≤5×10^(6)/kg)and CMV infection are closely related to the occurrence of PGF.SAA is a risk factor for PGF as well,and patients with SAA are more likely to develop PGF after transplantation than patients with AML,ALL and MDS.