[供受者性别匹配对急性白血病单倍体造血干细胞移植结局的影响]
[Influence of donor-recipient sex matching on outcomes of haploidentical hematopoietic stem cell transplantation for acute leukemia].
作者信息
Yu W J, Wang Y, Xu L P, Zhang X H, Liu K Y, Huang X J
机构信息
Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China.
出版信息
Zhonghua Xue Ye Xue Za Zhi. 2018 May 14;39(5):398-403. doi: 10.3760/cma.j.issn.0253-2727.2018.05.010.
To determine the influence of donor-recipient sex matching on outcome of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) for acute leukemia in the setting of T-cell-replete transplants. The retrospective study is based on 1 160 consecutive patients who received their first haplo-HSCT for acute leukemia between April 2002 and December 2014 at Peking University Institute of Hematology. The patients were divided into the sex-matched group and sex-mismatched group in terms of the recipient and donor sex. Then we conducted an analysis in four subgroups, male patients with male donors (M→M), male patients with female donors (F→M), female patients with female donors (F→F), and female patients with male donors (M→F). Transplant outcomes were measured in terms of hematopoietic recovery, acute graft versus host disease (aGVHD), relapse, nonrelapse mortality (NRM), disease-free survival (DFS) and overall survival (OS) in the above four subgroups. Then univariate and multivariate analysis were conducted. There was a higher 3-year and 5-year NRM but no difference in other transplant outcomes in sex-mismatched group when compared with the sex-matched group. F→M was compared with M→M, and the former group had higher 3-year and 5-year cumulative incidences of NRM (25.5% 16.1%, =0.002; 27.1% 17.3%, =0.002), decreased 5-year DFS (56.9% 64.4%, =0.044), decreased 3-year OS (62.6% 69.8%, =0.045). There was no significant difference in 3-year DFS and 5-year OS. There was no significant difference in grade Ⅱ-Ⅳ aGVHD and cGVHD incidence. When F→F group was compared with M→F group, only a higher grade Ⅱ-Ⅳ aGVHD incidence (43.9% 34.6%, =0.047) existed. F→M was proved to be the independent risk factor influencing NRM and OS in multivariate analysis. In haplo-HSCT for acute leukemia, the donor-recipient sex combination of male patients with female donors was of a poorer prognosis, so a male donor was a better choice for a male patient.
为确定供受者性别匹配对急性白血病患者在进行富含T细胞的单倍体造血干细胞移植（haplo-HSCT）时预后的影响。这项回顾性研究基于2002年4月至2014年12月期间在北京大学血液病研究所接受首次急性白血病单倍体HSCT的1160例连续患者。根据受者和供者的性别，将患者分为性别匹配组和性别不匹配组。然后我们对四个亚组进行了分析，即男性供者的男性患者（M→M）、女性供者的男性患者（F→M）、女性供者的女性患者（F→F）以及男性供者的女性患者（M→F）。在上述四个亚组中，根据造血恢复、急性移植物抗宿主病（aGVHD）、复发、非复发死亡率（NRM）、无病生存期（DFS）和总生存期（OS）来衡量移植结局。然后进行单因素和多因素分析。与性别匹配组相比，性别不匹配组的3年和5年NRM较高，但在其他移植结局方面无差异。将F→M与M→M进行比较，前一组的3年和5年NRM累积发生率较高（25.5%对16.1%，P = 0.002；27.1%对17.3%，P = 0.002），5年DFS降低（56.9%对64.4%，P = 0.044），3年OS降低（62.6%对69.8%，P = 0.04）。3年DFS和5年OS无显著差异。Ⅱ-Ⅳ级aGVHD和慢性移植物抗宿主病（cGVHD）发生率无显著差异。当将F→F组与M→F组进行比较时，仅Ⅱ-Ⅳ级aGVHD发生率较高（43.9%对34.6%，P = 0.047）。在多因素分析中，F→M被证明是影响NRM和OS的独立危险因素。在急性白血病的单倍体HSCT中，女性供者的男性患者的供受者性别组合预后较差，因此男性供者对男性患者是更好的选择。
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