单倍型造血干细胞移植后糖皮质激素耐药急性移植物抗宿主病的危险因素分析

目的分析单倍型造血干细胞移植(haplo-HSCT)后糖皮质激素耐药急性移植物抗宿主病(GVHD)的危险因素。方法回顾性分析2010年1月至2011年12月在北京大学血液病研究所接受haplo-HSCT后并发急性GVHD的成人急性髓系白血病/骨髓增生异常综合征患者的临床资料。结果共有85例急性GVHD患者纳入研究,男55例,女30例,中位年龄30(19~67)岁。糖皮质激素治疗后达到完全缓解(CR)53例(62.4%),部分缓解(PR)6例(7.1%),未缓解(NR)26例(30.6%)。Ⅰ/Ⅱ、Ⅲ/Ⅳ度急性GVHD组糖皮质激素治疗的CR率分别为66.2%(51/77)、25.0%(2/8)(χ^2=3.639,P=0.048);累及1个、2个靶器官急性GVHD组糖皮质激素治疗的CR率分别为77.4%(48/62)、21.7%(5/23)(χ^2=22.157,P<0.001);明尼苏达危险度积分标危、高危组糖皮质激素治疗的CR率分别为67.5%(52/77)、12.5%(1/8)(χ^2=7.153,P=0.004)。单因素和多因素分析均显示明尼苏达危险度积分高危和移植物单个核细胞量≥8.33×108/kg是发生糖皮质激素耐药急性GVHD的独立危险因素。明尼苏达积分标危组(77例)、高危组(8例)移植后22个月总生存率分别为(90.3±3.8)%、(75.0±15.3)%(χ^2=2.831,P=0.092);糖皮质激素治疗CR组(53例)、非CR组(32例)移植后22个月总生存率分别为(95.2±3.4)%、(78.6±7.9)%(χ^2=5.287,P=0.021)。结论明尼苏达危险度积分和移植物单个核细胞数可以预测haplo-HSCT后糖皮质激素耐药的急性GVHD。

Risk factors analysis for steroid-resistant acute graft versus host disease after haploidentical hematopoietic stem cell transplantation

Objective To analyze the risk factors of steroid resistant acute graft-versus-host disease(aGVHD)after haploidentical hematopoietic stem cell transplantation(haplo-HSCT).Methods The clinical data of adult patients with acute myeloid leukemia(AML)/Myelodysplastic syndrome(MDS)who developed aGVHD after haplo-HSCT in Peking University Institute of Hematology from January 1st,2010 to December 31st,2012 were retrospectively reviewed.Results A total of 85 patients were enrolled in the study,including 55 males and 30 females,with a median age of 30(19-67)years.After steroid therapy,there were 53(62.4%),6(7.1%)and 26(30.6%)patients achieved complete remission(CR),partial remission(PR)and non-remission(NR),respectively.The CR rates of the gradeⅠ/ⅡandⅢ/ⅣaGVHD by steroid therapy were 66.2%(51/77)vs 25.0%(2/8)(χ^2=3.639,P=0.048),respectively.The CR rates of the patients with aGVHD involving 1 target organ and 2 target organs were 77.4%(48/62)vs 21.7%(5/23)(χ^2=22.157,P<0.001).The CR rates of patients with standard risk(SR)and high risk(HR)Minnesota risk score was 67.5%(52/77)vs 12.5%(1/8)(χ^2=7.153,P=0.004).The mononuclear cells≥8.33×108/kg and the HR Minnesota risk score were independent risk factors for steroid-resistant aGVHD in multivariate analysis.Between Minnesota risk score SR(77 cases)and HR(8 cases)groups,the OS rates at 22 months after transplantation were(90.3±3.8)%vs(75.0±15.3)%(χ^2=2.831,P=0.092).After steroid treatment for aGVHD,the OS rates at 22 months in the CR group(53 cases)and non-CR group(32 cases)were(95.2±3.4)%vs(78.6±7.9)%(χ^2=5.287,P=0.021)respectively.Conclusion The Minnesota risk score and mononuclear cells count are effective tool for predicting steroid-resistant aGVHD after haplo-HSCT.