摘要
目的 探讨异基因造血干细胞移植(allo-HSCT)后急性移植物抗宿主病(aGVHD)的发生及其危险因素.方法 总结2004年10月至2008年12月治疗的72例allo-HSCT患者的临床资料.回顾性分析患者各临床因素与aGVHD发生的关系.结果 32例患者发生Ⅰ~Ⅳ度aGVHD,累积发生率44.4%.其中Ⅰ度8例(11.1%),Ⅱ度13例(18.1%),Ⅲ度7例(9.7%),Ⅳ度4例(5.6%).单因素分析显示疾病种类、抗人类T淋巴细胞球蛋白(ATG)的应用、疾病状态、预处理方案、供者类型、供受者血型不合、回输CD34+细胞数量、移植早期感染以及HLA配型均与aGVHD的发生有关(均P<0.1).多因素分析(COX regression)确定不含ATG的GVHD预防方案(HR=2.94,P<0.001)、HLA配型不合(HR=2.58,P<0.005)以及无关供者(HR=1.97,P<0.01)是发生aGVHD的主要危险因素.结论 aGVHD是allo-HSCT的重要并发症,HLA配型不合以及无关供者是aGVHD发生的主要危险因素.
Objective To explore the incidence and risk factors of acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods The clinical data of 72 cases allo-HSCT from Oct 2004 to Dec 2008 were analyzed. Thirteen factors possibly correlated with the development of aGVHD were analyzed. Results aGVHD was developed in 32 cases (44.4 %), in which grades Ⅰ aGVHD was 11.1%, gradesⅡaGVHD was 18.1%, and grades Ⅲ-Ⅳ aGVHD was 15.3 %. The univariate analysis showed that diagnosis, the status of disease, use ATG, conditioning regimen, donor type,ABO blood group disparity between donor and recipient, CD34+ cell number, early engraftment and neutropenic infection, HLA locus were associated with the occurence of aGVHD (P 〈0.1). On the COX regression mode, an increased risk of aGVHD was associated with HLA mismatch (HR =2.58, P 〈0.005), GVHD prophylaxis without ATG (HR =2.94, P 〈 0.001), and unrelated donor (HR =1.97, P 〈0.01). Conclusion aGVHD is a common complication after allo-HSCT, and HLA mismatch and unrelated donor are independent risk factors for aGVHD.
出处
《白血病.淋巴瘤》
CAS
2010年第12期714-717,共4页
Journal of Leukemia & Lymphoma
关键词
造血干细胞移植
移植
同种
移植物抗宿主病
HLA抗原
组织供者
回归分析
Hematopoietic stem cell transplantation
Transplantation, homologous
Graft vs hostdisease
HLA antigensi Tissue donors
Regression analysis