成人人类白细胞抗原全相合与不相合造血干细胞移植后急性移植物抗宿主病的临床特点与预后

 目的 比较成人人类白细胞抗原(HLA)全相合与HLA不相合异基因造血干细胞移植(allo-HSCT)后急性移植物抗宿主病(aGVHD)的临床特点与疗效。方法 回顾性分析2010年1月至2011年12月于北京大学血液病研究所进行亲缘allo-HSCT患者的临床病历资料,分析不同类型移植后aGVHD的发病类型与特点以及临床疗效的差异。结果 544例患者中,HLA不相合移植后的aGVHD发生率为50.2%,明显高于HLA全相合移植(20.4%,P<0.001),且发生得更早,但Ⅲ°~Ⅳ° aGVHD的累积发生率两组之间差异并无统计学意义(4.5%比6.8%, P=0.066);全相合移植中肠道aGVHD发生率较高(31.1%),而在不相合移植中以皮肤aGVHD为主(66.5%),肠道和肝脏aGVHD发生率均较全相合移植低;全相合移植发生aGVHD时发热患者比例较不相合移植低(28.9% 比47.6%,P=0.028);全相合移植与不相合移植相比,aGVHD总体治愈率低,特别是Ⅲ°~Ⅳ° aGVHD最终疗效差,二线治疗后的完全缓解率低于不相合移植(88.9%比98.8%,P=0.006),aGVHD相关病死率高于不相合移植(11.1%比2.4%,P=0.024)。结论 HLA不相合移植后aGVHD发生率明显高于全相合患者,但重度aGVHD发生率两组间差异无统计学意义,两组患者一线治疗缓解率相近,但HLA不相合移植患者二线治疗后aGVHD总体缓解率更高。

A comparison of clinical characteristics and prognosis of adult acute graft-versus-host disease between human leukocyte antigen-identical and -mismatched allogeneic hematopoietic stem cell transplantation

Objective To compare the clinical characteristics and prognosis of acute graft-versus-host disease (aGVHD) between patients undergoing human leukocyte antigen (HLA)-identical and HLA-mismatched allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods Cinical data of 544 patients receiving related allo-HSCT in Institute of Hematology of Peking University from January 2010 to December 2011 were retrospectively analyzed. The clinical features of aGVHD including manifestations and prognosis between HLA-identical and HLA-mismatched transplantation were compared. Results The cumulative incidence of aGVHD in related HLA-mismatched transplant was 50.2%, which was significantly higher than that of HLA-identical transplant (20.4%, P<0.001). However, the cumulative incidence of grade Ⅲ°-Ⅳ° aGVHD between the two groups was comparable (4.5% vs 6.8%, P=0.066). Gut aGVHD accounted for 31.1% in HLA-identical transplant while cutaneous aGVHD was the dominant area in HLA-mismatched transplant (66.5%). The incidence of gut and liver aGVHD in HLA-mismatched patients was also lower than that in HLA-identical patients. The proportion of patients with aGVHD accompanied by fever was higher in HLA-mismatched patients than in HLA-identical patients (47.6% vs 28.9%,P=0.028). The cure rate of aGVHD in identical transplant was lower than that in mismatched transplant, especially for grade Ⅲ°-Ⅳ° aGVHD. The complete remission rate after second-line anti-GVHD therapies was lower than that of mismatched transplant (88.9% vs 98.8%, P=0.006). More patients died of aGVHD in identical transplant compared with mismatched transplant (11.1% vs 2.4%,P=0.024).Conclusion More patients who received HLA-mismatched allo-HSCT develop into aGVHD compared with HLA-identical transplant. But the incidence of severe aGVHD between HLA-identical and -mismatched is comparable. The overall cure rate of HLA-mismatched transplant is significantly higher than that of HLA-identical transplant.