[Analysis of Relapse after Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Hematological Malignancies: A Single-center Study].

Jia-Pei Lu, Shu-Peng Wen, Fu-Xu Wang, Shu-Hui Li, Zhi-Yun Niu, Ying Wang, Zi-Wei Zhou, Zheng Xu, Zhen-Zhen Wang, Xue-Jun Zhang
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引用次数: 0

Abstract

Objective: 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.

Methods: 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).

Results: 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).

Conclusion: 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.

恶性血液病患者异基因造血干细胞移植后复发分析:一项单中心研究。
目的:分析恶性血液病患者同种异体造血干细胞移植(allogeneic hematopoietic stem cell transplantation, alloc - hsct)后的生存、预后因素及复发预防情况,探讨免疫重建、人白细胞抗原缺失(human白细胞抗原loss, HLA-loss)与移植后复发的关系。方法:回顾性分析2012年7月至2020年6月47例同种异体造血干细胞移植后复发的血液系统恶性肿瘤患者,其中20例进行了匹配-同胞供体移植(MSD), 26例进行了单倍体移植(HID), 1例进行了匹配-非亲属供体移植(MUD)。采用多因素分析分析与复发后总生存(PROS)相关的危险因素。结果:47例患者均成功植入。累积发病率Ⅱ-Ⅳ级、Ⅲ/Ⅳ级急性移植物抗宿主病(aGVHD)和慢性移植物抗宿主病(cGVHD)分别为40.4%、10.6%和31.9%。HID组Ⅱ-Ⅳ级和Ⅲ/Ⅳ级aGVHD发生率分别为42.3%和11.5%,MD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 d NK细胞绝对计数> 190细胞/μl患者的PROS高于NK细胞绝对计数≤190细胞/μl患者(P=0.021)。所有患者1年和3年的pro分别为68.1%和28.4%,而HID组为78.9%和40.3%,MD组为54.4%和14% (P=0.048)。多因素分析显示Ⅱ-ⅣaGVHD分级和复发时间< 3个月是PROS的独立危险因素(p)。结论:同种异体造血干细胞移植后复发的血液恶性肿瘤患者单倍体移植的治疗效果优于匹配供体移植。移植后30天高NK细胞绝对计数可使PROS增加。Ⅱ-ⅣaGVHD分级和复发时间< 3个月对移植后恶性血液病复发患者的长期生存有预后意义。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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