1. [Analysis of Relapse after Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Hematological Malignancies: A Single-center Study]
- Author
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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, and Xue-Jun, Zhang
- Subjects
Hematologic Neoplasms ,Siblings ,Hematopoietic Stem Cell Transplantation ,Graft vs Host Disease ,Humans ,Neoplasm Recurrence, Local ,Retrospective Studies - Abstract
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 count190 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 relapse3 months were independent risk factors of PROS (P0.05).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 relapse3 months have prognostic significance for long-term survival of patients with relapsed hematological malignancies after transplantation.恶性血液病异基因造血干细胞移植后复发单中心临床分析.分析恶性血液病患者异基因造血干细胞移植(allo-HSCT)后复发的生存情况、预后影响因素及复发的防治,探讨免疫重建、人类白细胞抗原丢失等与移植后复发的关系.回顾性分析2012年7月至2020年6月行allo-HSCT后复发的47例恶性血液病患者临床资料,同胞HLA全合移植(MSD)20例,亲缘单倍体移植(HID)26例,非血缘HLA全合移植(MUD)1例,对可能影响复发后总生存率(PROS)的危险因素进行多因素分析.47例患者均成功植入,移植后Ⅱ-Ⅳ和Ⅲ/Ⅳ度急性移植物抗宿主病(aGVHD)发生率分别为40.4%和10.6%,慢性移植物抗宿主病(cGVHD)的发生率为31.9%。HID组Ⅱ-Ⅳ度aGVHD、Ⅲ/Ⅳ度aGVHD发生率分别为42.3%、11.5%,全合 (MD)组分别为38.1%、9.5%(P=0.579,P=1.000),两组cGVHD发生率分别为34.6%、28.6%(P=0.659)。移植后30 d NK细胞绝对值计数190 cells/μl的患者比≤190 cells/μl的患者PROS高(P=0.021)。全部患者移植后1、3年PROS分别为68.1%、28.4%,HID组分别为78.9%、40.3%,MD组分别为54.4%、14%(P=0.048)。多因素分析结果显 示,发生Ⅱ-Ⅳ度aGVHD、复发时间3个月是影响PROS的危险因素(P0.05).恶性血液病allo-HSCT后复发患者行单倍体移植疗效比全相合移植好,移植后30 d NK细胞绝对值计数高可提高PROS,移植后发生Ⅱ-Ⅳ度aGVHD、复发时间3个月对移植后复发患者的长期生存具有预后意义.
- Published
- 2022