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[血液系统疾病患者二次异基因造血干细胞移植术后口腔黏膜炎的临床分析]

[Clinical analysis of oral mucositis after secondary allogeneic hematopoietic stem cell transplantation in patients with hematological diseases].

作者信息

Zhu X L, Wang J Z, Fu H X, Han T T, Xu Z L, Zhang X H, Xu L P, Huang X J, Wang Y

机构信息

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China.

出版信息

Zhonghua Xue Ye Xue Za Zhi. 2024 Dec 14;45(12):1078-1084. doi: 10.3760/cma.j.cn121090-20240701-00240.

Abstract

This study aimed to investigate the clinical characteristics of oral mucositis (OM) in patients with hematological diseases who received secondary allogeneic hematopoietic stem cell transplantation (allo-HSCT) . This study retrospectively analyzed data on 58 patients with hematological diseases who underwent secondary allo-HSCT at the Peking University People's Hospital from January 2018 to December 2023. The control group included 116 randomized patients after primary allo-HSCT during this period (1:2 ratio) with matched gender, age, and diagnosis. The incidence of OM and overall survival (OS) were compared between the two groups. The secondary allo-HSCT and control groups reported 17 (29.31%) and 16 (13.79%) cases that developed OM (=0.014), whereas 10 (17.24%) and 7 (6.03%) developed grade ≥3 OM (=0.019). The median time for OM to occur was 4 days (1-9 days) and 5 days (1-10 days) posttransplantation in the secondary allo-HSCT and control groups, respectively. The multivariate analysis revealed that the use of whole-body radiation therapy as the main pretreatment regimen was an independent risk factor for OM occurrence (=0.019). Among patients with OM, an age of <55 years is a risk factor for developing grade 3-4 OM (=0.028). All patients who underwent the secondary allo-HSCT received granulocyte implantation. The median time of granulocyte implantation in 17 patients with OM was 14 days posttransplantation, whereas the median time of granulocyte implantation in patients without OM was 12 days posttransplantation. The difference was not statistically significant (=0.721). The presence of OM did not affect the occurrence of acute graft-versus-host disease (=0.938). No statistically significant difference was observed in the 2-year OS rate between patients with and without OM during the secondary allo-HSCT (51.9% 50.4%, =0.943). No statistically significant difference was observed in the 2-year OS rate between patients with OM undergoing the secondary allo-HSCT and those undergoing the primary allo-HSCT (51.9% 81.3%, =0.185) . The proportion of patients with concurrent OM was significantly increased in the secondary allo-HSCT, and the severity was more severe. Whether or not to merge OM does not affect granulocyte implantation, acute graft-versus-host disease incidence, and 2-year OS rate.

摘要

本研究旨在调查接受二次异基因造血干细胞移植(allo-HSCT)的血液病患者口腔黏膜炎(OM)的临床特征。本研究回顾性分析了2018年1月至2023年12月在北京大学人民医院接受二次allo-HSCT的58例血液病患者的数据。对照组包括同期接受首次allo-HSCT的116例随机患者(比例为1:2),性别、年龄和诊断相匹配。比较两组之间OM的发生率和总生存期(OS)。二次allo-HSCT组和对照组分别有17例(29.31%)和16例(13.79%)发生OM(P=0.014),而发生≥3级OM的分别有10例(17.24%)和7例(6.03%)(P=0.019)。二次allo-HSCT组和对照组OM发生的中位时间分别为移植后4天(1-9天)和5天(1-10天)。多因素分析显示,以全身放疗作为主要预处理方案是OM发生的独立危险因素(P=0.019)。在发生OM的患者中,年龄<55岁是发生3-4级OM的危险因素(P=0.028)。所有接受二次allo-HSCT的患者均接受了粒细胞植入。17例发生OM的患者粒细胞植入的中位时间为移植后14天,而未发生OM的患者粒细胞植入的中位时间为移植后12天。差异无统计学意义(P=0.721)。OM的存在不影响急性移植物抗宿主病的发生(P=0.938)。二次allo-HSCT期间发生OM和未发生OM的患者2年OS率差异无统计学意义(51.9%对50.4%,P=0.943)。二次allo-HSCT发生OM的患者与首次allo-HSCT的患者2年OS率差异无统计学意义(51.9%对81.3%,P=0.185)。二次allo-HSCT中并发OM的患者比例显著增加,且严重程度更严重。是否合并OM不影响粒细胞植入、急性移植物抗宿主病发生率和2年OS率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/823d/11886692/75306330f427/cjh-45-12-1078-g001.jpg

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