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目的:评价异基因造血干细胞移植治疗恶性血液病的疗效。方法:对1999年12月至2010年1月间在湘雅医院接受异基因造血干细胞移植(allo-HSCT)的104例恶性血液病患者进行回顾性分析。采用Kaplan-Meier法计算移植后患者移植相关死亡率(TRM)、复发率(RR)、5年总生存率(OS)及5年无病生存率(DFS),并对影响预后的各因素进行统计学分析。结果:101例重建造血。至随访终点,重度急性移植物抗宿主病(aGVHD)的发生率为15.38%,广泛型慢性移植物抗宿主病(cGVHD)发生率为25.53%。TRM及RR分别为15.66%和21.76%,5年OS及DFS分别为(73.49±4.59)%和(63.10±5.32)%,其中急性髓系白血病(AML)患者分别为(63.00±9.51)%和(49.30±9.96)%;慢性粒细胞白血病(CML)患者分别为(83.87±5.06)%和(74.55±6.79)%。生存分析显示女性、重度aGVHD、难治性恶性血液病是预后不良的危险因素,进一步多因素分析显示重度aGVHD、难治性恶性血液病为预后不良的独立危险因素(P<0.05)。重度aGVHD、难治性恶性血液病组患者5年DFS分别为(48.22±12.69)%及(42.09±12.31)%。重度aGVHD、HLA不合、非血缘移植组患者TRM明显高于各自对照组(57.14%vs.4.81%,33.33%vs.10.41%,26.09%vs.9.28%;均P<0.05)。难治性恶性血液病患者RR明显高于其对照组(41.09%vs.15.63%,P<0.05)。结论:allo-HSCT可有效延长恶性血液病患者的无病生存时间,是恶性血液病治疗的重要方法。重度aGVHD、难治性恶性血液病是影响恶性血液病患者allo-HSCT预后的主要危险因素。
Objective: To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation in the treatment of hematologic malignancies. METHODS: A retrospective analysis was performed on 104 patients with hematologic malignancies who underwent allo-HSCT at Xiangya Hospital from December 1999 to January 2010. The transplant-related mortality (TRM), recurrence rate (RR), 5-year overall survival (OS) and 5-year disease-free survival (DFS) were calculated by Kaplan-Meier method, and the factors affecting the prognosis Statistical analysis. Results: 101 cases of reconstruction of hematopoiesis. At the end of follow-up, the incidence of severe acute graft-versus-host disease (aGVHD) was 15.38%, and the incidence of extensive chronic graft-versus-host disease (cGVHD) was 25.53%. TRM and RR were 15.66% and 21.76%, respectively. The 5-year OS and DFS were (73.49 ± 4.59)% and (63.10 ± 5.32)%, respectively. The patients with acute myeloid leukemia were 63.00 ± 9.51% (49.30 ± 9.96)%, respectively. The patients with chronic myeloid leukemia (CML) were (83.87 ± 5.06)% and (74.55 ± 6.79)%, respectively. Survival analysis showed that women with severe aGVHD and refractory hematologic malignancy were risk factors for poor prognosis. Further multivariate analysis showed that severe aGVHD and refractory hematologic malignancy were independent risk factors for poor prognosis (P <0.05). The 5-year DFS of patients with severe aGVHD and refractory hematologic malignancies were (48.22 ± 12.69)% and (42.09 ± 12.31)%, respectively. The TRM in patients with severe aGVHD and HLA incompatibility and non-blood transfusion group were significantly higher than those in the control group (57.14% vs.4.81%, 33.33% vs.10.41%, 26.09% vs.9.28%, all P <0.05). The RR of refractory hematologic malignancies was significantly higher than that of the control group (41.09% vs.15.63%, P <0.05). Conclusion: Allo-HSCT can effectively prolong the disease-free survival time of patients with hematologic malignancies and is an important method for the treatment of hematologic malignancies. Severe aGVHD, refractory hematologic malignancies are the major risk factors affecting the prognosis of allo-HSCT in patients with hematologic malignancies.