移植前铁负荷对非肝炎相关性重度再生障碍性贫血异体造血干细胞移植预后的影响

Chineae Journal of Organ Transplantation Pub Date : 2019-03-20 DOI:10.3760/CMA.J.ISSN.0254-1785.2019.03.003

Yuanyuan Shi, Sudong Zhang, Gui-xin Zhang, W. Zhai, Yi He, Rong-li Zhang, Qiao-ling Ma, A. Pang, Donglin Yang, Jialin Wei, Yong Huang, E. Jiang, Mingzhe Han

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Overall survival (OS), hematopoietic reconstitution and common complications after allo-HSCT were analyzed. \n \n \nResults \nThe median pre-transplantation SF value was 798.7(52.0-11060.0l) ng/ml. Patients with pre-transplantation iron overload had a higher incidence of cytomegaloviremia (P=0.041), delayed recovery of neutrophil/platelet (P=0.001, P=0.005 respectively) and transfusion-dependence in donor-recipient blood group-matched patients (P=0.043) after allo-HSCT. The 3-year OS was (65.1±7.1) % in iron overload group and (93.3±3.7) % in control group (P=0.001). Multivariate analysis indicated that 3-year OS was independently correlated with pre-transplantation iron overload (P=0.022), blood group of donor & recipient (P=0.015), early bacteremia (P=0.003) and cytomegaloviremia (P=0.003). \n \n \nConclusions \nIron overload is common in patients with non-hepatitis-related SAA before transplantation. 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摘要

目的探讨铁超载对非肝炎相关性重度再生障碍性贫血(SAA)患者同种异体造血干细胞移植(allogeneic hematopoietic stem cell transplantation，简称alloo - hsct)预后的影响。方法回顾性分析2012年7月至2018年7月下旬在同一中心接受同种异体造血干细胞移植的98例非肝炎相关性SAA患者的临床资料。在造血干细胞移植前2个月内测定血清铁蛋白(SF)。按SF水平分为铁超载组(SF>800.0 ng/ml, n=49)和对照组(SF<800.0 ng/ml, n=49)。分析同种异体造血干细胞移植后的总生存期(OS)、造血重建及常见并发症。结果移植前SF值中位数为798.7(52.0 ~ 11060.0l) ng/ml。移植前铁负荷患者在同种异体造血干细胞移植后巨细胞病毒血症(P=0.041)、中性粒细胞/血小板恢复延迟(P=0.001, P=0.005)和输血依赖发生率较高(P=0.043)。铁负荷组3年OS为(65.1±7.1)%，对照组为(93.3±3.7)% (P=0.001)。多因素分析显示，3年OS与移植前铁负荷(P=0.022)、供受体血型(P=0.015)、早期菌血症(P=0.003)、巨细胞病毒血症(P=0.003)独立相关。结论移植前非肝炎相关性SAA患者铁负荷较高。移植前铁超载对同种异体造血干细胞移植后的OS、造血重建和巨细胞病毒血症有显著影响。关键词:异基因造血干细胞移植;铁蛋白;再生障碍性贫血;存活率

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Effect of pre-transplantation iron overload on the outcomes of allogeneic hematopoietic stem cell transplantation patients with non-hepatitis-related severe aplastic anemia

Objective To explore the effect of iron overload on the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients with non-hepatitis related severe aplastic anemia (SAA). Methods The clinical data were retrospectively analyzed for 98 patients with non-hepatitis related SAA undergoing allo-HSCT from July 2012 to late July 2018 at a single center. Serum ferritin (SF) was measured within 2 months before HSCT. They were divided into iron overload (SF>800.0 ng/ml, n=49) and control (SF<800.0 ng/ml, n=49) groups according to SF level. Overall survival (OS), hematopoietic reconstitution and common complications after allo-HSCT were analyzed. Results The median pre-transplantation SF value was 798.7(52.0-11060.0l) ng/ml. Patients with pre-transplantation iron overload had a higher incidence of cytomegaloviremia (P=0.041), delayed recovery of neutrophil/platelet (P=0.001, P=0.005 respectively) and transfusion-dependence in donor-recipient blood group-matched patients (P=0.043) after allo-HSCT. The 3-year OS was (65.1±7.1) % in iron overload group and (93.3±3.7) % in control group (P=0.001). Multivariate analysis indicated that 3-year OS was independently correlated with pre-transplantation iron overload (P=0.022), blood group of donor & recipient (P=0.015), early bacteremia (P=0.003) and cytomegaloviremia (P=0.003). Conclusions Iron overload is common in patients with non-hepatitis-related SAA before transplantation. Pre-transplantation iron overload has a significant impact on OS, hematopoietic reconstitution and cytomegaloviremia after allo-HSCT. Key words: Allogeneic hematopoietic stem cell transplantation; Ferritin; Aplastic anemia; Survival rate

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Chineae Journal of Organ Transplantation

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