亲缘HLA不相合与无关HLA全相合移植疗效比较
首发时间:2014-01-16
摘要:目的:比较亲缘HLA不相合和无关HLA全相合供者造血干细胞移植(HSCT)对血液肿瘤患者的疗效。 方法:2002年10月至2012年12月我院 82例接受亲缘HLA不相合和92例接受无关HLA全相合供者HSCT的血液肿瘤患者纳入回顾性分析,比较二组患者移植后造血重建、移植物抗宿主病(GVHD)、复发和生存情况。结果:两组患者在年龄、性别、原发疾病类型、移植前疾病状态均无显著性差异(P >0.05)。除亲缘组2例死于预处理相关毒性(RRT)、1例死于细菌败血症;无关组3例患者死于RRT、1例死于感染性休克外,其余患者均获得造血重建。亲缘组与无关组白细胞重建中位时间分别为11 (9-22) 天和12 (10-29) 天(P=0.726)、血小板重建为 13 (10-40) 天和14 (10-60) 天(P=0.863)。亲缘组和无关组急性GVHD发生率分别62.2%和54.3%(P=0.295),其中Ⅲ-Ⅳ急性GVHD的发生率分别15.9%和9.8%(P=0.229);慢性GVHD的发生率分别为28.4%和45.1%(P=0.036)、其中广泛性慢性GVHD 发生率分别为9.0%和12.2%(P=0.525);GVHD致死率两组分别为8.5% 和10.9%(P=0.605)。两组10年累积复发率分别为21.5%±5.7%和37.6%±7.3%(P=0.194),10年总生存率分别为50.1%±6.1%和50.5%±6.7%(P=0.501)、无病生存率为48.8%±6.1%和46.3%±6.2%(P=0.873)。结论:亲缘HLA不相合供者与无关HLA全相合供者HSCT对血液肿瘤患者具有同等的安全性和疗效,在无HLA全相合同胞供者的情况下,亲缘HLA不相合移植比无关HLA全相合移植具有供者来源不受限制和根据疾病需要及时选择的优势。
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Comparison of clinical efficacy between HLA-mismatched related and HLA-matched unrelated donor hematopoietic stem cell transplantation for hematopoietic malignancies
Abstract:To compare the clinical efficacy of HLA-mismatched related donor (MRD) and HLA-matched unrelated donor (MUD) hematopoietic stem cell transplantation (HSCT) for hematopoietic malignancies.175 patients with hematopoietic malignancies undergoing allogeneic HSCT (allo-HSCT) (83 from MRD and 92 from MUD) from October 2002 to December 2012 were enrolled in this retrospective study. Hematopoietic engraftment, graft versus host disease (GVHD), relapse, overall survival (OS) and disease-free survival (DFS) were compared between MRD and MUD group. There was no significant difference between MRD and MUD group regarding age, gender, disease type and disease status pre-transplantation (all P>0.05). Except that 2 and 3 patients died of regimen-related toxicity (RRT), 1 of septicemia and 1 of septic shock, respectively, in MRD and MUD group, other patients obtained hematopoietic engraftment. The median time to neutrophil and platelet engraftment was 11 (range, 9 to 22) days and 13 (range, 10 to 40) days in MRD group, and it was 12 (range, 10 to 29) days and 14 (range, 10 to 60) days in MUD group (P=0.726, P=0.863). The incidence of I-IV acute GVHD was 62.2% and 54.3% in MRD and MUD group (P=0.295), and the incidence of chronic GVHD was 28.4% and 45.1% in MRD and MUD group (P=0.036).The mortality of GVHD was 8.5% and 10.9% in MRD and MUD group (P=0.605).The 10-year OS and DFS were 50.1%±6.1% and 48.8%±6.1% in MRD group, compared with 50.5%±6.7% and 46.3%±6.2% in MUD group(P=0.501, P=0.873, respectively). The 10-year cumulative incidence of relapse was 21.5%±5.7% and 37.6%±7.3% in MRD and MUD group (P=0.194). MRD is equivalent to MUD in efficacy and safety. Without HLA-matched related donors, MRD is superior to MUD because donor source is unlimited and choice of treatment could be made promptly according to disease status.
Keywords: Hematology Human leukocyte antigen Donor Efficacy Hematopoietic stem cell transplantation.
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