[人类白细胞抗原相合与不相合异基因造血干细胞移植后成人急性移植物抗宿主病临床特征及预后比较]

[A comparison of clinical characteristics and prognosis of adult acute graft-versus-host disease between human leukocyte antigen- identical and -mismatched allogeneic hematopoietic stem cell transplantation].

作者信息

Zhao Xiaosu, Xu Lanping, Liu Daihong, Han Tingting, Wang Yu, Zhang Xiaohui, Yan Chenhua, Chen Huan, Han Wei, Wang Jingzhi, Zhao Ting, Li Yan, Zhang Bo, Zhao Xiangyu, Liu Kaiyan, Huang Xiaojun

机构信息

Institute of Hematology and People's Hospital, Peking University, Beijing 100044, China.

Institute of Hematology and People's Hospital, Peking University, Beijing 100044, China. Email:

出版信息

Zhonghua Nei Ke Za Zhi. 2014 Jan;53(1):35-9.

PMID:24674726

Abstract

OBJECTIVE

To compare the clinical characteristics and prognosis of acute graft-versus-host disease (aGVHD) between patients undergoing human leukocyte antigen (HLA)-identical and HLA-mismatched allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODS

Clinical data of 544 patients receiving related allo-HSCT in Institute of Hematology of Peking University from January 2010 to December 2011 were retrospectively analyzed. The clinical features of aGVHD including manifestations and prognosis between HLA-identical and HLA-mismatched transplantation were compared.

RESULTS

The cumulative incidence of aGVHD in related HLA-mismatched transplant was 50.2%, which was significantly higher than that of HLA-identical transplant (20.4%, P < 0.001). However, the cumulative incidence of grade III°-IV° aGVHD between the two groups was comparable (4.5% vs 6.8%, P = 0.066). Gut aGVHD accounted for 31.1% in HLA-identical transplant while cutaneous aGVHD was the dominant area in HLA-mismatched transplant (66.5%). The incidence of gut and liver aGVHD in HLA-mismatched patients was also lower than that in HLA-identical patients. The proportion of patients with aGVHD accompanied by fever was higher in HLA-mismatched patients than in HLA-identical patients (47.6% vs 28.9%, P = 0.028). The cure rate of aGVHD in identical transplant was lower than that in mismatched transplant, especially for grade III°-IV° aGVHD. The complete remission rate after second-line anti-GVHD therapies was lower than that of mismatched transplant (88.9% vs 98.8%, P = 0.006). More patients died of aGVHD in identical transplant compared with mismatched transplant (11.1% vs 2.4%, P = 0.024).

CONCLUSION

More patients who received HLA-mismatched allo-HSCT develop into aGVHD compared with HLA-identical transplant. But the incidence of severe aGVHD between HLA-identical and -mismatched is comparable. The overall cure rate of HLA-mismatched transplant is significantly higher than that of HLA-identical transplant.

摘要

目的

比较接受人类白细胞抗原（HLA）相合与HLA不相合异基因造血干细胞移植（allo-HSCT）患者的急性移植物抗宿主病（aGVHD）的临床特征及预后。

方法

回顾性分析2010年1月至2011年12月在北京大学血液病研究所接受亲缘allo-HSCT的544例患者的临床资料。比较HLA相合与HLA不相合移植中aGVHD的临床特征，包括表现及预后。

结果

亲缘HLA不相合移植中aGVHD的累积发生率为50.2%，显著高于HLA相合移植（20.4%，P<0.001）。然而，两组间III°-IV° aGVHD的累积发生率相当（4.5%对6.8%，P = 0.066）。肠道aGVHD在HLA相合移植中占31.1%，而皮肤aGVHD在HLA不相合移植中占主导地位（66.5%）。HLA不相合患者肠道和肝脏aGVHD的发生率也低于HLA相合患者。HLA不相合患者中伴有发热的aGVHD患者比例高于HLA相合患者（47.6%对28.9%，P = 0.028）。相合移植中aGVHD的治愈率低于不相合移植，尤其是III°-IV° aGVHD。二线抗GVHD治疗后的完全缓解率低于不相合移植（88.9%对98.8%，P = 0.006）。与不相合移植相比，相合移植中更多患者死于aGVHD（11.1%对2.4%，P = 0.024）。