嵌合现象对伊朗 HLA 配型相同的骨髓移植后移植物抗宿主病、疾病复发及生存的影响。

Effects of chimerism on graft-versus-host disease, disease recurrence, and survival after HLA-identical marrow transplantation in Iran.

作者信息

Alimoghaddam Kamran, Ghaffari Hamid, Foroughi Forough, Chardouli Bahram, Sanaat Zohreh, Bahar Babak, Mousavi Asadollah, Iravani Masoud, Ghavamzadeh Ardeshir

机构信息

Hematology-Oncology and BMT Research Center, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Arch Iran Med. 2006 Apr;9(2):99-103.

PMID:16649348

Abstract

BACKGROUND

The coexistence of recipient's and donor's hematopoietic systems after allogeneic marrow transplantation is called mixed chimerism.

OBJECTIVE

The objective of this study was to evaluate the effects of MC on graft-versus-host disease (GVHD), disease recurrence, and survival after HLA identical marrow transplantation in a transplant center in Iran.

METHODS

The association of MC with acute GVHD, disease recurrence, survival, and relapse-free survival was investigated in 91 patients who underwent either bone (n = 12) or peripheral blood (n = 79) HLA-identical marrow transplantation. Chimerism was assessed using multiplex amplification of short tandem repeats (STR). Patients had thalassemia (n = 19), acute myelogenous leukemia (AML) (n = 29), acute lymphocytic leukemia (ALL) (n = 20), chronic myelogenous leukemia (CML) (n = 18), and other diseases (n = 5). The median age was 21 (range: 3 - 50) years. There were 38 (42%) female and 53 (58%) male participants. Conditioning was made through busulfan plus cyclophosphamide in 34 patients; busulfan plus fludarabin in 51 patients; and busulfan plus fludarabin plus antithymocyte globulin in 6 patients. The median follow-up was 13 months.

RESULTS

On day +30, complete chimerism (CC) was observed in 72 (79%) patients, MC in 15 (17%), and no chimerism in 4 patients. The incidence of acute GVHD was significantly (P = 0.01) lower in mixed chimeras than in complete chimeras. There was no significant difference in acute GVHD grade (I, II vs. III, IV) between the two groups. The incidence of relapse was 18%. There was no difference in relapse rate between MC and CC groups. Overall survival was 89%. There was no significant difference in the overall survival between MC and CC group (96% vs. 85%, respectively). Relapse-free survival was 80% that was not significantly different between the two groups.

CONCLUSION

Despite some previous reports, we found no significant difference in the survival and relapse rates between MC and CC groups.

摘要

背景

异基因骨髓移植后受者和供者造血系统共存被称为混合嵌合体。

目的

本研究的目的是评估混合嵌合体（MC）对伊朗一家移植中心 HLA 相同骨髓移植后移植物抗宿主病（GVHD）、疾病复发和生存的影响。

方法

在 91 例接受骨髓（n = 12）或外周血（n = 79）HLA 相同骨髓移植的患者中，研究了 MC 与急性 GVHD、疾病复发、生存和无复发生存的相关性。使用短串联重复序列（STR）的多重扩增评估嵌合体情况。患者患有地中海贫血（n = 19）、急性髓性白血病（AML）（n = 29）、急性淋巴细胞白血病（ALL）（n = 20）、慢性髓性白血病（CML）（n = 18）和其他疾病（n = 5）。中位年龄为 21 岁（范围：3 - 50 岁）。有 38 名（42%）女性和 53 名（58%）男性参与者。34 例患者通过白消安加环磷酰胺进行预处理；51 例患者通过白消安加氟达拉滨进行预处理；6 例患者通过白消安加氟达拉滨加抗胸腺细胞球蛋白进行预处理。中位随访时间为 13 个月。

结果

在 +30 天时，72 例（79%）患者观察到完全嵌合体（CC），15 例（17%）为 MC，4 例无嵌合体。混合嵌合体中急性 GVHD 的发生率显著低于完全嵌合体（P = 0.01）。两组之间急性 GVHD 分级（I、II 级与 III、IV 级）无显著差异。复发率为 18%。MC 组和 CC 组之间的复发率无差异。总生存率为 89%。MC 组和 CC 组之间的总生存率无显著差异（分别为 96%和 85%）。无复发生存率为 80%，两组之间无显著差异。