摘要
目的:探讨异基因造血干细胞移植(hematopoietic stem cell transplantation,HSCT)后中枢神经系统(central nervous system,CNS)并发症的危险因素以及对患者生存的影响。方法:采用回顾性分析的方法,收集中南大学湘雅医院血液科2016年9月至2019年9月行异基因HSCT的323例患者的临床资料,对发生CNS并发症的患者并发症发生的时间、常见的症状等临床资料进行统计学描述。采用单因素及多因素分析方法分析异基因HSCT后CNS并发症发生的危险因素,并进行生存分析。结果:在323例行异基因HSCT的患者中,发生CNS并发症的有32例,发生CNS并发症的中位时间为移植后32(-1~584) d,常见的症状为意识障碍(78.1%)、抽搐(59.4%)、头痛(12.5%)。单因素分析结果显示:中性粒细胞植活情况、血小板(platelet, PLT)植活情况、血清巨细胞病毒(cytomegalovirus,CMV)DNA阳性、合并急性移植物抗宿主病(acute graft versus host disease,aGVHD)、供者选择是影响异基因HSCT后CNS并发症发生的相关临床因素(分别P=0.011,P<0.001,P=0.006,P<0.001,P=0.035)。多因素分析结果显示:PLT植活延迟或未植活、合并aGVHD为CNS并发症发生的危险因素(均P<0.001)。生存分析结果显示:发生CNS并发症的患者1年总生存率(overall survival rate,OS)和2年OS均明显低于未发生的患者(55%±9%vs 89%±2%,37%±11%vs 85%±3%;均P<0.001);发生CNS并发症的患者1年无病生存率(disease free survival rate,DFS)和2年DFS均明显低于未发生患者(55%±9%vs 88%±2%,29%±11%vs 83%±3%;均P<0.001);发生CNS并发症的患者1年移植相关病死率(transplantation-related mortality,TRM)和2年TRM均明显高于未发生患者(45%±9%vs 8%±2%,58%±11%vs 11%±2%;均P<0.001)。结论:PLT植活延迟或未植活、合并aGVHD为异基因HSCT后CNS并发症发生的危险因素,提示当异基因HSCT患者PLT植活延迟或未植活,或是合并aGVHD时,需警惕CNS并发症的发生。与未发生CNS并发症的患者相比,发生该并发症的患者往往预后不良。
Objective: To investigate the risk factors as well as their impact on patients’ survival of central nervous system(CNS) complications following allogeneic hematopoietic stem cell transplantation(HSCT).Methods: All relevant clinical data from a total of 323 patients, who underwent allogeneic HSCT in Xiangya Hospital of Central South University from September 2016 to September2019, were retrospectively reviewed in this study. The complications’ occurrence time,common symptoms and some other clinical data of the patients who developed CNS complications were analyzed descriptively. The risk factors for CNS complications following allogeneic HSCT were analyzed through univariate and multivariate analysis.And the survival analysis was conducted as well.Results: Among the 323 patients who underwent allogeneic HSCT, 32 patients developed CNS complications. These complications occurred in these patients at a median of 32(range from-1 to 584) d after transplantation. Common symptoms were disturbance of consciousness(78.1%), convulsion(59.4%), and headache(12.5%). Univariate analysis showed that there were significant differences in neutrophil engraftment, platelet(PLT)engraftment, serum cytomegalovirus(CMV) DNA positive, combined with acute graftversus-host disease(a GVHD), donor selection(P=0.011, P<0.001, P=0.006, P<0.001 or P=0.035, respectively). Multivariate analysis showed that the delay or the failure of PLT engraftment(P<0.001) and combined with a GVHD(P<0.001) were the risk factors for CNS complications. Survival analysis showed that the 1-year overall survival rate(OS) and2-year OS were significantly lower in patients who developed CNS complications than in the non-CNS complication group(55%±9% vs 89%±2%, 37%±11% vs 85%±3%;both P<0.001). The 1-year disease-free survival rate(DFS) and 2-year DFS were significantly lower in patients who developed CNS complications than in the non-CNS complication group(55%±9% vs 88%±2%, 29%±11% vs 83%±3%;both P<0.001). The 1-year transplantation-related mortality(TRM) and 2-year TRM were significantly higher in patients who developed CNS complications than those in the non-CNS complication group(45%±9% vs 8%±2%, 58%±11% vs 11%±2%;both P<0.001).Conclusion: The delay or the failure of PLT engraftment and combined with a GVHD are the risk factors for CNS complications. The facts indicate that we should prevent CNS complications when patients who underwent allogeneic HSCT with the delay or the failure of PLT engraftment or a GVHD. Compared with non-CNS complication group, patients who developed CNS complications usually have poor prognosis.
作者
陈旭
彭敏源
付斌
陈焱
华娟
曾枞
徐雅靖
CHEN Xu;PENG Minyuan;FU Bin;CHEN Yan;HUA Juan;ZENG Cong;XU Yajing(Department of Hematology,Xiangya Hospital,Central South University,Changsha 410008,China)
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2020年第10期1176-1184,共9页
Journal of Central South University ：Medical Science
基金
国家自然科学基金(8197011063)。
关键词
中枢神经系统并发症
异基因造血干细胞移植
危险因素
生存分析
central nervous system complications
allogeneic hematopoietic stem cell transplantation
risk factors
survival analysis
