急性白血病患者异基因造血干细胞移植术后复发危险因素分析

目的 探讨急性白血病(AL)患者异基因造血干细胞移植(allo-HSCT)术后复发危险因素.方法 回顾性分析郑州大学第一附属医院造血干细胞移植中心自2003年12月至2013年12月行allo-HSCT的157例AL患者的临床资料,应用Cox回归法分析受者年龄、性别、疾病类型、初诊白细胞计数、诱导疗程数、人类白细胞抗原(HLA)配型、急性移植物抗宿主病(aGVHD)、慢性移植物抗宿主病(cGVHD)、移植物来源、巨细胞病毒(CMV)感染与移植后复发的关系.结果 157例患者中32例在移植后24个月内复发.单因素分析结果示:初诊白细胞计数(P=0.023)、诱导疗程数(P=0.074)、移植物来源(P=0.044)、cGVHD(P=0.033)是allo-HSCT后复发的影响因素.多因素Cox回归分析结果示:诱导疗程数(P=0.027)、cGVHD(P=0.011)是allo-HSCT后复发的独立影响因素.结论 诱导疗程数多、未发生cGVHD是allo-HSCT后复发的危险因素.

Analysis of risk factors for relapse in patients with acute leukemia following allogeneic hematopoietic stem cell transplantation

Objective To investigate the risk factors for relapse in patients with acute leukemia (AL) following allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods 157 patients undergoing allo-HSCT in the First Affiliated Hospital of Zhengzhou University from Dec.2003 to Dec.2013 were analyzed retrospectively.Cox regression analysis was used to analyze the relationships between age,gender,type of disease,initial white blood cell count,induction course,HLA allele type,acute graft-versus-host disease (aGVHD),chronic GVHD (cGVHD),graft source,cytomegalovirus (CMV) infection and relapse following transplantation.Results 32 cases relapsed during 24 months after transplantation.Univariate analysis showed that the differences between initial white blood cell count (P =0.023),induction course (P =0.074),graft source (P =0.044),cGVHD (P =0.033) and recurrence after allo-HSCT were considered statistically significant.Multivariate Cox regression analysis showed that induction course (P =0.027) and cGVHD (P =0.011) were the independent factors of relapse after allo-HSCT.Conclusion Induction courses and without the occurrence of cGVHD are the risk factors for relapse post-transplantation.