异基因造血干细胞移植治疗恶性血液病的预后分析

 目的　探讨异基因造血干细胞移植（allo-HSCT）治疗恶性血液病的预后相关因素。方法　1997年7月至2008年8月，对26例血液病患者行allo-HSCT，其中急性白血病（AL）14例，慢性髓系白血病（CML）10例，骨髓增生异常综合征（MDS）2例；移植供受体22例为同胞HLA全相合，4例为同胞HLA不全相合。结果　所有患者达到稳定的供者植入，随访至今，累积总生存（OS）率为63.9 %，累积无病生存（DFS）率为62.6 %；15例（57.7 %）发生移植物抗宿主病（GVHD），其中急性GVHD 8例（30.8 %）Ⅲ～Ⅳ度4例（15.4 %）]，慢性GVHD 7例；HLA全相合与 HLA不全相合移植间GVHD发生率差异有统计学意义（P＝0.014）；复发4例；死亡7例。单因素分析结果显示，发生Ⅳ度GVHD、巨细胞病毒（CMV）感染是影响患者生存的高危因素，组间比较差异有统计学意义（P＝0.05和P＝0.027）。结论　allo-HSCT是目前治疗恶性血液病的有效方法，提高allo-HSCT疗效的关键是控制移植相关并发症，特别是GVHD和感染。

Prognostic analysis of allogeneic hematopoietic stem cell transplantation in treating patients with malignant hematological diseases

Objective To explore the clinical related prognostic factors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in treating malignant hematological diseases. Methods From September 1997 to August 2008,a total of 26 patients with hematological diseases were treated with allo-HSCT from HLA identical-sibling and haplo-identical donors in our hospital, including 14 patients with acute leukemias,10 with chronic myeloid leukemias,and 2 myelodysplastic syndromes. Results All patients achieved sustained full donor type engraftment. The cumulative overall survival (OS) was 63.9 %,and cumulative disease free survival (DFS) was 62.6 %. Fifteen patients had graft-versus-host disease (GVHD) (57.7 %),including 8 acute GVHD(aGVHD) (30.8 %) (grade Ⅲ-Ⅳ aGVHD was 15.4 %) and 7 chronic GVHD. GVHD between HLA identical-sibling and haplo-identical donors was different and there was statistic difference between the two groups (P=0.014). 4 patients relapsed,7 patients died. The univariate analysis showed OS were correlated with grade Ⅳ aGVHD (P=0.05) and CMV infection (P=0.027). Conclusion Allo-HSCT is effective for the cure of patients with malignant hematological diseases. The key to improve the efficacy of HSCT is to reduce the incidence of transplant-related complications,especially GVHD and infection.