Lu Jia-Pei, Wen Shu-Peng, Wang Fu-Xu, Li Shu-Hui, Niu Zhi-Yun, Wang Ying, Zhou Zi-Wei, Xu Zheng, Wang Zhen-Zhen, Zhang Xue-Jun
Department of Hematology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China.
Department of Hematology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China,E-mail: zhxjhbmu126.com.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2022 Aug;30(4):1238-1243. doi: 10.19746/j.cnki.issn.1009-2137.2022.04.042.
To analyze the survival, prognostic factors, and prevention of relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with hematological malignancies, and explore the relationship between immune reconstruction, loss of human leukocyte antigen (HLA-loss) and relapse after transplantation.
From July 2012 to June 2020, 47 patients with hematological malignancies who relapsed after allo-HSCT were retrospectively analyzed, including 20 cases undergoing matched-sibling donor transplantation (MSD), 26 cases undergoing haploidentical transplantation (HID), and 1 case undergoing matched-unrelated donor transplantation (MUD). Multivariate analysis was used to analyze the risk factors related to post-relapse overall survival (PROS).
All the 47 patients were implanted successfully. The cumulative incidence of grade Ⅱ-Ⅳ, Ⅲ/Ⅳ acute graft-versus-host disease (aGVHD) and chronic GVHD (cGVHD) was 40.4%, 10.6%, and 31.9%, respectively. The incidence of grade Ⅱ-Ⅳ and Ⅲ/Ⅳ aGVHD in HID group was 42.3% and 11.5%, while in MD group was 38.1% and 9.5% (P=0.579, P=1.000), and the incidence of cGVHD in the two groups was 34.6% and 28.6% (P=0.659). The PROS of patients with NK cell absolute count > 190 cells/μl 30 days after transplantation was higher than that of patients with NK cell absolute count ≤190 cells/μl (P=0.021). The 1-year and 3-year PROS of all the patients was 68.1% and 28.4%, respectively, while in the HID group was 78.9% and 40.3%, in the MD group was 54.4% and 14% (P=0.048). Multivariate analysis showed that grade Ⅱ-Ⅳ aGVHD and time of relapse < 3 months were independent risk factors of PROS (P<0.05).
The therapeutic effect of haploidentical transplantation in patients with relapsed hematological malignancies after allo-HSCT is better than that of matched donor transplantation. The high absolute count of NK cells 30 days after transplantation can increase PROS. Grade Ⅱ-Ⅳ aGVHD and time of relapse < 3 months have prognostic significance for long-term survival of patients with relapsed hematological malignancies after transplantation.
分析血液系统恶性肿瘤患者异基因造血干细胞移植（allo-HSCT）后的生存情况、预后因素及复发预防，并探讨免疫重建、人类白细胞抗原丢失（HLA-loss）与移植后复发之间的关系。
回顾性分析2012年7月至2020年6月间47例allo-HSCT后复发的血液系统恶性肿瘤患者，其中同胞全相合供者移植（MSD）20例，单倍体相合移植（HID）26例，非血缘全相合供者移植（MUD）1例。采用多因素分析方法分析复发后总生存（PROS）相关危险因素。
47例患者均成功植入。Ⅱ-Ⅳ度、Ⅲ/Ⅳ度急性移植物抗宿主病（aGVHD）及慢性移植物抗宿主病（cGVHD）的累积发生率分别为40.4%、10.6%和31.9%。HID组Ⅱ-Ⅳ度及Ⅲ/Ⅳ度aGVHD发生率分别为42.3%和11.5%，MSD组分别为38.1%和9.5%（P=0.579，P=1.000），两组cGVHD发生率分别为34.6%和28.6%（P=0.659）。移植后30天NK细胞绝对计数>190个/μl的患者PROS高于NK细胞绝对计数≤190个/μl的患者（P=0.021）。所有患者1年和3年PROS分别为68.1%和28.4%，HID组分别为78.9%和40.3%，MSD组分别为54.4%和14%（P=0.048）。多因素分析显示，Ⅱ-Ⅳ度aGVHD及复发时间<3个月是PROS的独立危险因素（P<0.05）。
allo-HSCT后复发的血液系统恶性肿瘤患者单倍体相合移植的治疗效果优于全相合供者移植。移植后30天NK细胞绝对计数高可提高PROS。Ⅱ-Ⅳ度aGVHD及复发时间<3个月对allo-HSCT后复发的血液系统恶性肿瘤患者长期生存有预后意义。
