移植物抗宿主病对26例血液肿瘤患者异基因造血干细胞移植后长期生存的影响

背景与目的:移植物抗宿主病(graft-versus-hostdisease,GVHD)是异基因造血干细胞移植的一个主要并发症,亦是影响移植结果的重要因素。一些研究显示,不管是急性GVHD或慢性GVHD,都伴随有较强的移植物抗白血病(graft-versus-leukemia,GVL)作用,这种正向效应与降低异基因造血干细胞移植后白血病复发率及延长受者无病生存密切相关。本研究探讨GVHD的发生及其对异基因造血干细胞移植结果的影响。方法:回顾分析1995年3月至2005年10月26例血液肿瘤患者接受异基因造血干细胞移植术后GVHD的发生、肿瘤复发及生存情况,分析GVHD与血液肿瘤复发率、生存率的关系。结果:异基因造血干细胞移植后中位随访时间为20个月(2～127个月),20例患者术后发生GVHD(76.9%),其中1例受者复发(1/20),6例未出现GVHD的受者3例复发(3/6),两组复发率比较差异有显著性(P<0.05);移植后无病生存16例,死亡10例,Kaplan-Meier生存曲线示3年无病生存率为60%;发生GVHD的受者其无病生存率(15/20)较无GVHD受者(1/6)高(log-rank=7.30,P<0.05),发生GVHD时移植患者发生死亡的风险明显下降(RR值为0.20,P<0.05)。20例发生GVHD的受者,经治疗17例达完全缓解(completeresponse,CR),3例未达CR。17例CR受者中,无病生存15例;而未达CR的3例受者则无一例生存,两组生存率比较差异有显著性(P<0.05)。结论:GVHD是影响异基因造血干细胞移植结果的重要因素。GVHD治疗效果与移植受者无病生存密切相关,早期识别急性GVHD并予及时处理是治疗成功的关键。

Influence of graft-versus-host disease on long-term survival of 26 patients with hematologic malignancies after transplantation

BACKGROUND & OBJECTIVE: Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), and also is an important factor affecting the outcome of transplantation. Some researches showed that either acute or chronic GVHD is often accompanied by graft-versus-leukemia (GVL) effect, and this positive effect is associated with the decrease of leukemia relapse and the prolongation of disease-free survival of recipients. This study was to assess the influence of GVHD on the outcome of allo-HSCT. METHODS: Twenty-six patients with hematologic malignancies received allo-HSCT from Mar. 1995 to Oct. 2005. The occurrence of GVHD, relapse of leukemia, and survival of recipients were analyzed retrospectively, and the correlations of GVHD to leukemia relapse and patients' survival were evaluated. RESULTS: With a median follow-up of 20 months (range 2-127 months) after transplantation, 20 (76.9%) patients developed GVHD, 1 of which had tumor relapsed; 3 of the 6 patients without GVHD had tumor relapsed. The relapse rate was significantly lower in the recipients with GVHD than in the recipients without GVHD (P<0.05). After transplantation, 16 patients survived disease-freely, and 10 died. Kaplan-Meier survival curves showed that the 3-year disease-freely survival rate was 60%. The disease-freely survival rate was significantly higher in the recipients with GVHD than in the recipients without GVHD (15/20 vs. 1/6, log-rank=7.30, P<0.05). Cox regression models showed a significantly decreased risk of death in the recipients with GVHD (risk ratio=0.2, P<0.05). Of the 20 recipients with GVHD, 17 achieved complete response (CR), 15 of whom survived disease-freely; no survived in the 3 patients who did not achieve CR. The disease-freely survival rate was significantly higher in the recipients achieved CR than in the recipients did not (P<0.05). CONCLUSIONS: GVHD is an important factor that may influence the outcome of allo-HSCT. Treatment efficacy of GVHD is significantly associated with the disease-free survival of recipients. Early recognition and treatment of acute GVHD is the key factor of successful treatment.