摘要
目的 探讨单倍型造血干细胞移植治疗移植前处于不同肿瘤负荷的血液恶性肿瘤的安全性及影响生存的危险因素.方法 回顾性分析2007年1月至2013年5月70例接受单倍型造血干细胞移植的血液恶性肿瘤患者临床资料,根据移植前肿瘤残留的情况分成低肿瘤负荷组、中肿瘤负荷组、高肿瘤负荷组,分析移植前肿瘤残留对生存的影响.同时分析这些患者的预处理方案、移植相关并发症及复发等情况.结果 随访截至2014年1月1日,中位随访34.05个月（7.4～83.6个月）.全部患者均获得植入,Ⅱ～Ⅳ度急性移植物抗宿主病（GVHD）发生率47.14％（33/70）,其中Ⅲ～Ⅳ度急性GVHD发生率21.4％（15/70）.慢性广泛型GVHD发生率20.0％（14/70）.至随访期结束总生存率68.6％,移植相关死亡率12.8％,复发死亡率18.6％.低肿瘤负荷组、中肿瘤负荷组、高肿瘤负荷组2年生存率分别为91.7％、72.7％、33.3％,移植前肿瘤残留是影响生存的高危因素（移植前中、高肿瘤负荷组2年生存率比较,P=0.016）.结论 单倍型造血干细胞移植在血液恶性肿瘤的治疗中是安全有效的,移植前肿瘤残留为影响患者总生存及导致复发的重要原因,对预后不良的血液恶性肿瘤患者,应该在缓解后尽早接受造血干细胞移植来减少移植后的复发,提高总生存.
Objective To explore the efficiency and prognosis of hematological malignancies treated by haploidentical hematopoietic stem cell transplantation.Methods 70 patients who received haploidentical hematopoietic stem cell transplantation were analyzed retrospectively.According to tumor burden before transplantation,the patients were divided into three groups,the low tumor burden group,the mediate tumor burden group and the high tumor burden group.And then the effection of the tumor burden to survival was analyzed,and the engraftment,GVHD,infection,conditioning related toxicity,relapse and survival rate were also observed.Results The follow-up was terminated on January 1,2014.Follow-ups were performed for a median of 34.05 （7.4-83.6） months after transplantation.All patients achieved engraftments.The cumulative incidence of GVHD of grades 2-4 was 47.14 % （33/70） and that of grades 3-4 was 21.4 % （15/70）.The chronic extensive GVHD was 20.0 % （14/70）.The overall survival was 68.6 %.Transplant-related mortality was 12.8 % and the relapse was 18.6 %.The overall survivals in low tumor burden group,mediate tumor burden group,high tumor burden group were 91.67 %,72.7 %,33.3 % respectively.By SPSS 20.0,tumor burden was the high risk factor affecting the survival （low tumor group vs high tumor group,mediate tumor group vs high tumor group,low tumor group vs high tumor group,P =0.000,P =0.038,P =0.016）.Conclusions Haploidentical hematopoietic stem cell transplantation in hematological malignancies is safe and effective.And for hematological malignancies with poor prognosis disease,it should be accepted the HSCT as soon as possible after remission in order to reduce the recurrence rate of malignancy.
出处
《白血病．淋巴瘤》
CAS
2014年第7期420-423,共4页
Journal of Leukemia & Lymphoma
关键词
血液肿瘤
单倍型
造血干细胞移植
复发
肿瘤负荷
Hematopoietic neoplasms
Haploidentical
Hematopoietic stem cell transplantation
Relapse
Tumor burden
