摘要
目的:分析异基因造血干细胞移植(allo-HSCT)治疗骨髓增生异常综合征(MDS)的疗效及影响生存的相关因素。方法:对49例行allo-HSCT的MDS患者进行回顾性研究,应用Kaplan-Meier曲线和Log-rank检验分析总生存,并对影响患者预后的相关因素进行单因素和COX比例风险回归分析。结果:49例患者中年龄≥60岁10例,单倍体移植26例,中位随访13.7(0.4~65.4)个月,中性粒细胞植入中位时间13(7~25)d,血小板植入中位时间12(6~48)d,达到完全供者嵌合的中位时间为移植后15(9~51)d。Ⅱ~Ⅳ度急性移植物抗宿主病(aGVHD)及慢性移植物抗宿主病发生率分别为14.3%、27.9%,复发率为14.3%,年龄<60岁与年龄≥60岁患者的1年总生存率分别为77.0%、40.0%。年龄<60岁患者中,单倍体移植与全相合移植的1年总生存率分别为76.0%、78.0%。COX比例风险回归分析结果显示,年龄≥60岁的MDS患者生存率较60岁以下患者低(HR=3.5,95%CI 1.08~11.32,P=0.04),而移植前病程、移植时骨髓原始细胞比例、供者类型及Ⅱ~Ⅳ度aGVHD等对MDS患者总体生存无明显影响。结论:对于年龄<60岁MDS患者,allo-HSCT是有效的治疗方法。无HLA相合供者的患者,单倍体移植疗效与HLA全相合移植结果相似。对于年龄60~70岁的老年患者,如果体能状态和主要脏器功能良好,allo-HSCT亦可能是较好的治疗选择。
Objective:To analyze the efficacy of allogeneic hematopoietic stem cell transplantation(allo-HSCT)in the treatment of myelodysplastic syndrome(MDS)and survival related risk factors.Method:A retrospective study was performed on 49 patients with MDS who underwent allo-HSCT.The Kaplan-Meier curve and Log-rank test were used to analyze the overall survival,and prognostic factors were analyzed with COX proportional hazard regression.Result:Among the 49 patients underwent allo-HSCT,10 patients were aged≥60 years and 26 patients were transplanted from haploidentical donors.The median follow-up time was 13.7(0.4-65.4)months.The median time of granulocyte and platelet engraftment was 13(7-25)days and 12(6-48)days.The median time to complete donor chimerism was 15(9-51)days after transplantation.The incidence of gradeⅡ-Ⅳacute graft versus host disease(aGVHD)and chronic GVHD was 14.3%and 27.9%,respectively.The relapse rate was 14.3%.The 1-year overall survival rate in patients aged<60 years and≥60 years was 77.0%and 40.0%,respectively.In patient aged<60 years,the 1-year overall survival rate of patients transplanted from haploidentical donors and matched donors were 76.0%and 78.0%,respectively.COX proportional hazard regression analysis showed that patients aged≥60 years had a lower survival rate than patients aged<60 years(HR=3.5,95%CI 1.08-11.32,P=0.04).However,the period from diagnosis to transplantation,the percentage of blasts in bone marrow,donor types andⅡ-Ⅳgrade aGVHD had no significant effect on overall survival.Conclusion:allo-HSCT is an effective treatment for patients with MDS aged<60 years.For patients without HLA-matched donors,haploidentical HSCT could achieve similar results to that of HLA-matched HSCT.For patients aged between 60-70 years old,allo-HSCT may be a feasible option if they are in good condition and without major organ comorbidities.
作者
於芳芳
杨隽
姜杰玲
蔡宇
李肃
许晓巍
赵初娴
蒋瑛
王椿
宋献民
万理萍
YU Fangfang;YANG Jun;JIANG Jieling;CAI Yu;LI Su;XU Xiaowei;ZHAO Chuxian;JIANG Ying;WANG Chun;SONG Xianmin;WAN Liping(Department of Hematology,Shanghai Jiao Tong University Affiliated Shanghai General Hospital,Shanghai,200080,China)
出处
《临床血液学杂志》
CAS
2020年第1期44-48,共5页
Journal of Clinical Hematology
基金
上海市科委专项经费(No:17411968300).
关键词
骨髓增生异常综合征
异基因造血干细胞移植
生存影响因素
myelodysplastic syndrome
allogeneic hematopoietic stem cell transplantation
survival analysis
作者简介
通信作者:万理萍,E-mail:lipingwan@sjtu.edu.cn
