摘要
本研究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)和慢性移植物抗宿主病(cGVHD)的危险因素及其与预后的关系。对我院100例行allo-HSCT患者的临床资料进行了总结,对aGVHD、cGVHD的发生率和危险因素及其对复发和生存的影响进行了分析。结果表明:31例患者发生Ⅱ-Ⅳ度aGVHD,累积发生率为34.4%;14例发生Ⅲ-Ⅳ度aGVHD,累积发生率为17.7%。HLA相合程度与aGVHD的发生无显著相关性(p>0.05)。曾发生的Ⅱ-Ⅳ度aGVHD是发生cGVHD的危险因素(HR=2.303,p=0.088),女性因素为保护性因素(HR=0.401,p=0.055)。发生cGVHD者复发率较低。发生Ⅱ-Ⅳ度aGVHD为影响总生存率(OS)的危险因素(p<0.05),重度(Ⅲ-Ⅳ)aGVHD患者的死亡率极高(81.0%),与0-Ⅰ度患者的死亡率(35.7%)相比有显著性差异(p=0.000)。结论:GVHD和移植物抗肿瘤效应(GVL)尚不能分离,但GVL的益处可能被GVHD相关死亡因素抵消,因此需积极防治重度aGVHD。局限型cGVHD可能是长期生存的有益因素。
The study was aimed to investigate the incidences and risk factors of acute and chronic graft-versus-host diseases （GVHD） and to clarify their effects on relapse and survival of recipients after allogeneic hematopoietic stem cell transplantation （allo-HSCT）. The clinical data of 100 cases of allo-HSCT were retrospectively analyzed. The incidences and risk factors of aGVHD and cGVHD, relapse and survival were studied. The results showed that 31 cases developed aGVHD of Ⅱ - Ⅳ grade （ 34.4% ） and 14 cases developed aGVHD of Ⅲ - Ⅳ grade （ 17.7% ）. HLA matched or mismatched did not show significant difference in the development of aGVHD of Ⅱ - Ⅳ grade （p 〉 0.05 ）. Previous occurrence of aGVHD was the risk factor for cGVHD （ HR = 2. 303 ,p = 0.088 ）. The female was a favorable factor for cGVHD （ HR = 0.401 ,p = 0.055）. The relapse rate was lower in patients who developed cGVHD. The development of aGVHD of Ⅱ - Ⅳ grade was the risk factor for overall survival （p 〈0.05）. The mortality of patients with aGVHD of Ⅲ - Ⅳ grade and mortality of patients with aGVHD of 0 -Ⅰ grade were 81.0% and 35, 7% respectively, there was very significant difference betweem them （p = 0. 000 ）. In conclusion, till now GVHD and graft-versus-leukemia （GVL） effect can not be separated. The positive effect of GVL could be counteracted by GVHD-related mortality. It is necessary to prevent and control the development of severe aGVHD. The development of local cGVHD may be beneficial to the long-terrn disease-free survival of patients after allo-HSCT.
出处
《中国实验血液学杂志》
CAS
CSCD
2009年第4期994-998,共5页
Journal of Experimental Hematology
