Fei Y, Hu X X, Chen Q, Huang A J, Cheng H, Ni X, Qiu H Y, Gao L, Tang G S, Chen J, Zhang W P, Yang J M, Wang J M
Department of Hematology, Institute of Hematology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
Department of Health Statistics, Second Military Medical University, Shanghai 200433, China.
Zhonghua Xue Ye Xue Za Zhi. 2019 Dec 14;40(12):990-995. doi: 10.3760/cma.j.issn.0253-2727.2019.12.004.
To investigate the relationship between donor chimerism and relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . The clinical data of 105 patients with acute myeloid leukemia (AML) who underwent allo-HSCT and recurrence-free survival>90 days from January 2010 to January 2019 were retrospectively analyzed. The bone marrow samples were collected at 15, 30, 60, 90, 180, 270, 360 days after transplantation. Donor chimerism was detected by single nucleotide polymorphism (SNP) -PCR. Of the 105 patients, 43 cases were male and 62 cases were female, with a median age of 38 (16-60) years. Till April 2019, the median follow-up was 843 (94-3 261) days. Ninety days after transplantation, 18 cases relapsed, 33 cases died, and 72 cases survived. The 3-year overall survival (OS) rate was (66.8±5.1) %, and the recurrence-free survival (RFS) rate was (65.1±5.0) %. Pre-transplant disease status, pre-transplant minimal residual disease (MRD) , and 90 day post-transplantation chimerism were independent risk factors related to RFS. The risk of recurrence was significantly increased in patients with a donor chimerism rate ≤97.24% at 90 days after transplantation[=6.921 (95% 2.669-17.950) , <0.001], which was considered as a sign of early relapse. SNP-PCR is an applicable method for detecting donor chimerism in patients after allo-HSCT. Chimerism rate equal or less than 97.24% at 90 days after transplantation predicts a higher risk of relapse.
探讨异基因造血干细胞移植(allo-HSCT)后供者嵌合率与复发之间的关系。回顾性分析2010年1月至2019年1月期间接受allo-HSCT且无复发生存>90天的105例急性髓系白血病(AML)患者的临床资料。在移植后15、30、60、90、180、270、360天采集骨髓样本。采用单核苷酸多态性(SNP)-PCR检测供者嵌合率。105例患者中,男性43例,女性62例,中位年龄为38(16-60)岁。截至2019年4月,中位随访时间为843(94-3261)天。移植后90天,18例复发,33例死亡,72例存活。3年总生存率(OS)为(66.8±5.1)%,无复发生存率(RFS)为(65.1±5.0)%。移植前疾病状态、移植前微小残留病(MRD)以及移植后90天的嵌合率是与RFS相关的独立危险因素。移植后90天供者嵌合率≤97.24%的患者复发风险显著增加[=6.921(95% 2.669-17.950),<0.001],这被视为早期复发的标志。SNP-PCR是检测allo-HSCT后患者供者嵌合率的一种适用方法。移植后90天嵌合率等于或低于97.24%预示着较高的复发风险。