难治复发急性白血病患者造血干细胞移植后感染相关死亡的分析

摘要：目的探讨难治复发急性白血病患者接受异基因造血干细胞移植（allo-HSCT）后感染相关死亡（IRM）的特点。方法回顾
分析127例接受allo-HSCT的难治复发急性白血病患者的临床资料，统计感染相关死亡情况并分析危险因素。结果观察期内
67 例死亡。5 年总生存率为（35.2±5.3）%，无病生存率为（30.8±5.6）%。28.3%（36/127）患者发生感染相关死亡。Ⅱ~Ⅳ°
aGVHD (P=0.049, OR=3.017)和移植后IFI（P=0.032, OR=3.223）是IRM的独立危险因素。结论感染作为移植相关死亡的主
要原因，相对于标危患者，在难治复发患者中占更高的比例。更多的关注严重GVHD后感染的预防和治疗力度是目前减少IRM
的主要措施。

Analysis of infection-related mortality after allogeneic hematopoietic stem cell transplantation in patients with refractory/relapse acute leukemia

Objective To investigate infection-related mortality(IRM) after allogeneic hematopoietic stem cell transplantation in patients with refractory/relapse acute leukemia.Methods We conducted a retrospective analysis of 127 patients with refractory/relapse acute leukemia and investigated the incidence,causes and risk factors of IRM.Results Sixty-seven of the patients died after the transplantation.The 5-year overall survival and disease-free survival was(35.2±5.3)% and(30.8±5.6)% among these patients,respectively.IRM occurred in 28.3%(36/127) of the patients.Multivariate analysis showed that grade II-IV acute graft-versus-host diseases(aGVDH,P=0.049,OR=3.017) and post-transplant invasive fungal infection(P=0.032,OR=3.223) were independent risk factors of IRM.Conclusion As a common cause of transplant-related mortality,IRM is more frequent in cases of refractory/relapse acute leukemia than in cases with a standard risk profile,and effective prophylaxis and treatment of severe GVHD remain currently the primary measures for reducing post-transplant IRM.