异基因造血干细胞移植后急性移植物抗宿主病的发生及其危险因素的探讨

Exploration of acute graft versus host disease and its risk factors after allo-hematopoietic stem cell transplantation

目的 探讨异基因造血干细胞移植 (allo HSCT)后急性移植物抗宿主病 (aGVHD)的发生率与预后的关系及其危险因素。方法 总结了 118例患者 12 0次的allo HSCT的临床资料。结果 6 3例患者发生了aGVHD ,累积发生率为 5 2 .5 7%。其中轻度aGVHD (Ⅰ～Ⅱ度 ) 4 6例 ,累积发生率38 91% ,重度aGVHD(Ⅲ～Ⅳ度 ) 17例 ,累积发生率 14 .17%。 12 0例次患者移植后 2年时总的累积疾病复发率为 14 .14 % ,其中无aGVHD组和轻度aGVHD组的累积复发率分别为 12 .4 8% (6例 )和 2 0 .5 3%(9例 ) ,重度aGVHD(Ⅲ～Ⅳ度 )组无一例复发 ,但无统计学意义 (P >0 .0 5 )。无aGVHD组和轻度、重度GVHD组患者 2年时的生存率分别为 6 1.4 0 % ,6 4 .0 8%和 17.6 5 % ,重度aGVHD组预后较差 (P <0 .0 1)。非血缘关系移植 ,HLA配型不合为发生aGVHD的危险因素。而与患者的年龄、性别、移植方式、疾病种类、分期、供受者性别和血型、输入细胞数等因素无关。结论 aGVHD是HSCT的重要并发症 ,发生时间越早 ,症状越重 ,预后越差。非血缘关系移植 ,HLA配型不合为发生aGVHD的危险因素。

Objective To explore the incidence, prognosis and risk factors of the acute graft versus host disease (aGVHD) after allo hematopoietic stem cell transplantation (allo HSCT). Methods The clinical data of 118 cases undergone 120 times of allo HSCT were analyzed. Result aGVHD was observed in 63 cases (52.57%) including 17 severe cases (14.17%). The patients with aGVHD had a poor outcome, the 2 year overall survival rates were 61.40%,64.08% and 17.65% for the non aGVHD, mild (degree Ⅰ～Ⅱ) and severe ( degree Ⅲ～Ⅳ) aGVHD groups respectively (P<0.01). However, the relapse rates were 12.48%, 20.53% and 0% with no statistic significance. Unrelated transplantation and HLA mismatch were the risk factors for aGVHD. Conclusion aGVHD is a common complication after allo HSCT, the earlier it takes place, the poorer the prognosis.