不同供者来源的造血干细胞移植后急性移植物抗宿主病的临床特征研究

目的 对比研究不同供者来源异基因造血干细胞移植(allo-HSCT)后患者发生急性移植物抗宿主病(aGVHD)受累部位及受累器官数的分布特征.方法 回顾性分析2007年11月至2008年12月进行的289例亲缘关系allo-HSCT患者的临床资料,分析不同类型allo-HSCT后aGVHD的发生情况、受累部位的分布特征及受累器官数的分布.结果 289例患者中166例(57.4%)发生aGVHD;轻度(Ⅰ～Ⅱ度)52.1%,重度(Ⅲ～Ⅳ度)11.0%.发生aGVHD的166例患者中累及皮肤116例(69.9%),消化道79例(47.6%),肝脏25例(15.1%);其中亲缘关系HLA全相合组皮肤型19例(42.2%),消化道型25例(55.6%),肝脏型12例(26.7%);HLA不全相合组皮肤型为97例(80.2%),消化道型54例(44.6%),肝脏型13例(10.7%).HLA不相合组皮肤型aGVHD发生率明显高于HLA全相合组(P=0.000).HLA全相合组累及皮肤的aGVHD的患者中Ⅱ度8例(17.8%),Ⅲ～Ⅳ度3例(6.6%);累及消化道的Ⅱ度aGVHD 22例(48.9%),Ⅲ～Ⅳ度3例(6.6%);HLA不全相合组累及皮肤aGVHD患者中Ⅱ度占38.8%,与HLA全相合组比较差异有统计学意义(P=0.01),Ⅲ～Ⅳ度占11.6%,与HLA全相合组无明显差异;累及消化道的Ⅱ度aGVHD 36例(29.8%),与HLA全相合组差异有统计学意义(P=0.028),Ⅲ～Ⅳ度18例(14.9%),与HLA相合组比无差异.166例aGVHD患者中累及1个器官的115例(69.3%),其中Ⅰ～Ⅱ度103例(62.0%),Ⅲ～Ⅳ度12例(7.2%);累及两个器官的48例(28.9%),其中Ⅱ度37例(22.3%),Ⅲ～Ⅳ度11例(6.6%);累及3个器官的仅3例(1.8%),均为Ⅲ度.结论 HLA不全相合组aGVHD中皮肤型比例明显高于HLA全相合组;HLA全相合与不全相合组比较,轻度皮肤受累或胃肠道受累所占比例差异有统计学意义,但重度者两组间无明显差别,对预后影响不大;aGVHD同时累及3个器官者重度aGVHD所占比例高.

Clinical characteristics of acute graft-versus-host disease among different donors of allogeneic hematopoietic stem cell transplantation

Objective To analyze the characteristics and the number of organs involved in acute graft-versus-host disease (aGVHD) among different donors of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods Clinical data were retrospectively analyzed in 289 patients received allo-HSCT in our hospital, between November 2007 and December 2008. Clinical features of the involved organs between different donors were compared. Results The cumulative incidence of aGVHD was 57.4% ( 166/289),grades Ⅰ - Ⅱ and grades Ⅲ - Ⅳ were 52. 1% and 11.0%, respectively. Skin was involved in 116 (69.9%) of the total 166 cases, gut 97 (47.6%), and liver 25 ( 15.1% ). Organs involved in HLA-identicai sibling transplantation and in haplo-identical ones were skin 19(42.2% ), gut 25(55.6% ), and liver 12(26.7%), and 79 ( 80.2% ), 54 (44.6%) and 13 ( 10.7% ) respectively. More aGVHD involvements of skin were found in HLA haplo-identical HSCT than in HLA identical sibling HSCT ( P = 0. 000 ). The involvement of skin grade Ⅱ was 8 ( 17.8% ) and 38.8% (P =0.01 ), gut grade Ⅱ was 22(48.9% ) and 36(29.8%) (P = 0. 028) in HLA identical sibling transplantation and in haploidentical HSCT, repectively.The incidences of aGVHD grades Ⅰ to Ⅱ and grade Ⅲ to Ⅳ were 103(62.0% ) versus 12(7.2% ) in the single organ involved group, 37 (22.3%) versus 11 (6.6%) in the double organs involved group, and 0% versus 3( 1.8% ) in the triple organs involved group. Conclusion The percentage of aGVHD with skin involvement in haploidentical HSCT is significantly higher than that in HLA identical HSCT. There is a significant difference in mild skin or GI aGVHD between HLA matched and mismatched HSCT, but no difference in severe skin or GI aGVHD between the two groups. The percentage of severe aGVHD was higher if three organs were involved.