[异基因外周血干细胞移植后早期供体嵌合状态的预后意义]
[Prognostic significance of early phase donor chimerism after allogeneic peripheral blood stem cell transplantation].
作者信息
Zhai W H, Liu Q Z, Shi Y Y, Li G, Sun J L, Chen X, Yao J F, Su X H, Ma Q L, Pang A M, He Y, Yang D L, Zhang R L, Huang Y, Wei J L, Feng S Z, Han M Z, Jiang E L
机构信息
Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
出版信息
Zhonghua Xue Ye Xue Za Zhi. 2018 Nov 14;39(11):932-936. doi: 10.3760/cma.j.issn.0253-2727.2018.11.012.
To evaluate the prognostic significance of early phase full donor chimerism (FDC) after myeloablative allogeneic peripheral blood stem cell transplantation (allo-PBSCT). The clinical data of 72 hematological patients received myeloablative allo-PBSCT from Feb. 2016 to Jul. 2017 were analyzed retrospectively. The median age was 36.5 years (range 4-59), 44 were males and 28 females. Of the donors, there were 35 HLA matched sibling donors, 27 haploidentical donors and 10 unrelated donors. Polymerase chain reaction amplification of short tandem repeat sequence (PCR-STR) was used to detect donor cell chimerism (DC) rate of recipient bone marrow at one, two and three months after transplantation. The median follow-up was 462 d (range: 47-805 d), 55 cases were still alive, and 45 cases were disease-free survival (DFS) at the end of follow-up. The 2-year overall survival (OS) and DFS were (68.9±7.7)% and (59.5±6.3)%, respectively. A number of 16 cases underwent relapses, with 2-year cumulative incidence of (24.1±5.3)%. The median time of recurrence was 157(32-374) d. Forty cases (55.6%) developed acute graft-versus-host diseases (aGVHD), with median time of 35.5 (13-90) d. Chronic GVHD (cGVHD) occurred in 23 patients (31.9%), with median time of 169 (94-475) d. Univariate analysis found the following factors were not related to OS, DFS or relapse rate (RR), including age, sex, blood type and sex of donor-recipient, occurrence of aGVHD and cGVHD. The OS and DFS in cases reached FDC and no FDC at two months after transplantation were (85.2±6.9)% (66.1±7.7)% (=0.051) and (76.7±7.7)% (48.9±8.1)% (=0.021), respectively. The RR rate in FDC group was lower than that in no FDC group [(16.6±6.8)% (30.4±7.8)%, =0.187, respectively]. The present study confirmed the important value for predicting the prognosis with whether or not the patients reached FDC at the early phase after allo-PBSCT. The OS and DFS in cases with FDC at two months after transplantation were significantly higher than those of no FDC patients.
评估清髓性异基因外周血干细胞移植（allo-PBSCT）后早期完全供者嵌合状态（FDC）的预后意义。回顾性分析2016年2月至2017年7月接受清髓性allo-PBSCT的72例血液病患者的临床资料。中位年龄为36.5岁（范围4 - 59岁），男性44例，女性28例。供者中，35例为HLA匹配的同胞供者，27例为单倍体相合供者，10例为无关供者。采用聚合酶链反应扩增短串联重复序列（PCR-STR）检测移植后1个月、2个月和3个月受者骨髓的供体细胞嵌合率（DC）。中位随访时间为462天（范围：47 - 805天），随访结束时55例仍存活，45例无病生存（DFS）。2年总生存（OS）率和DFS率分别为（68.9±7.7）%和（59.5±6.3）%。16例复发，2年累积发生率为（24.1±5.3）%。复发的中位时间为157（32 - 374）天。40例（55.6%）发生急性移植物抗宿主病（aGVHD），中位时间为35.5（13 - 90）天。23例（31.9%）发生慢性移植物抗宿主病（cGVHD），中位时间为169（94 - 475）天。单因素分析发现以下因素与OS、DFS或复发率（RR）无关，包括年龄、性别、血型以及供受者性别、aGVHD和cGVHD的发生情况。移植后2个月达到FDC和未达到FDC的患者的OS和DFS分别为（85.2±6.9）%（66.1±7.7）%（P = 0.051）和（76.7±7.7）%（48.9±8.1）%（P = 0.021）。FDC组的RR率低于未达到FDC组[分别为（16.6±6.8）%（30.4±7.8）%，P = 0.187]。本研究证实了allo-PBSCT后早期患者是否达到FDC对预后预测的重要价值。移植后2个月达到FDC的患者的OS和DFS显著高于未达到FDC的患者。
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