Chen Yan, Xu Yajing, Zhu Yan, Fu Gan, Liu Yi, Peng Jie, Fu Bin, He Qun, Wu Dengshu, Li Xiaolin, Zhao Xielan, Chen Fangping
Department of Hematology, Xiangya Hospital, Central South University, Changsha, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2011 Sep;36(9):859-64. doi: 10.3969/j.issn.1672-7347.2011.09.008.
To study the efficacy of allogeneic hemotopoietic stem cell transplantation (allo-HSCT) for hematological malignancy.
A total of 104 patients with hematological malignancy, who underwent allo-HSCT in Xiangya Hospital from December 1999 to January 2010, were retrospectively analyzed. Of the patients, the transplantation related mortality (TRM), relapse rate (RR), 5-year overall survival (OS) and disease free survival (DFS) were estimated by Kaplan-Meier analysis. The unfavorable prognostic factors were also statistically examined.
Hematopoietic reconstitution was achieved in 101 patients. At the last data of follow-up, the incidences of severe acute graft versus host disease (aGVHD) and extensive chronic GVHD were 15.38% and 25.53%, and the TRM and RR were 15.66% and 21.76%, respectively. The estimated 5-year OS and DFS for all patients were (73.49±4.59)% and (63.10±5.32)%, respectively. Those for acute myeloid leukemia (AML) patients were (63.00±9.51)% and (49.30±9.96)%, and those for chronic myeloid leukemia (CML) patients were (83.87±5.06)% and (74.55±6.79)%, respectively. The survival analysis suggested the poor prognostic factors for allo-HSCT recipients including female sex, severe aGVHD and refractory hematological malignancy. Further multivariate analyses revealed that severe aGVHD and refractory hematological malignancy were the independent risk factors of poor prognosis for the recipients (P<0.05). The 5-year DFS of severe aGVHD and refractory hematological malignancy patients was (48.22±12.69)% and (42.09±12.31)%, respectively. The TRM of severe aGVHD, HLA-mismatched graft and unrelated donor transplant was significantly higher than that of the corresponding control groups (57.14% vs. 4.81%, 33.33% vs. 10.41%, 26.09% vs. 9.28%; P<0.05). The RR of refractory hematological malignancy was significantly higher than that of the control group (41.09% vs. 15.63%, P<0.05).
The treatment of allo-HSCT can improve the disease free survival of patients with hematological malignany and is an important therapeutic method for hematological malignancy. Severe aGVHD and refractory hematological malignancy are the independent risk factors of poor prognosis for the allo-HSCT recipients with hematological malignancy.
研究异基因造血干细胞移植（allo-HSCT）治疗血液系统恶性肿瘤的疗效。
回顾性分析1999年12月至2010年1月在湘雅医院接受allo-HSCT的104例血液系统恶性肿瘤患者。采用Kaplan-Meier分析评估患者的移植相关死亡率（TRM）、复发率（RR）、5年总生存率（OS）和无病生存率（DFS）。同时对不良预后因素进行统计学检验。
101例患者实现造血重建。在最后一次随访数据时，重度急性移植物抗宿主病（aGVHD）和广泛慢性GVHD的发生率分别为15.38%和25.53%，TRM和RR分别为15.66%和21.76%。所有患者的估计5年OS和DFS分别为（73.49±4.59）%和（63.10±5.32）%。急性髓系白血病（AML）患者的5年OS和DFS分别为（63.00±9.51）%和（49.30±9.96）%，慢性髓系白血病（CML）患者的分别为（83.87±5.06）%和（74.55±6.79）%。生存分析提示allo-HSCT受者的不良预后因素包括女性、重度aGVHD和难治性血液系统恶性肿瘤。进一步多因素分析显示，重度aGVHD和难治性血液系统恶性肿瘤是受者预后不良的独立危险因素（P<0.05）。重度aGVHD和难治性血液系统恶性肿瘤患者的5年DFS分别为（48.22±12.69）%和（42.09±12.31）%。重度aGVHD、HLA配型不合的移植物和无关供者移植的TRM显著高于相应对照组（57.14%对4.81%，33.33%对10.41%，26.09%对9.28%；P<0.05）。难治性血液系统恶性肿瘤的RR显著高于对照组（41.09%对15.63%，P<0.05）。
allo-HSCT治疗可提高血液系统恶性肿瘤患者的无病生存率，是治疗血液系统恶性肿瘤的重要方法。重度aGVHD和难治性血液系统恶性肿瘤是allo-HSCT治疗血液系统恶性肿瘤受者预后不良的独立危险因素。
