ABO血型不合对异基因造血干细胞移植的影响
发布时间：2018-08-10 21:35
【摘要】：目的研究ABO血型不合对异基因造血干细胞移植(allo-HSCT)疗效的影响。 方法对2007年1月至2012年12月在我院行allo-HSCT的393例血液病患者的结果进行分析,其中同胞供者相合(IRD) allo-HSCT患者264例(67.2%),同胞供者不相合(MRD) allo-HSCT患者26例(6.6%),无关供者相合(IUD) allo-HSCT患者54例(13.7%),无关供者不相合(MUD) allo-HSCT患者24例(6.1%),半倍体allo-HSCT患者22例(5.6%),脐带血(UBC) allo-HSCT患者3例(0.8%)。393例患者中ABO血型不合者183例(46.6%)[主要不合组患者77例(19.6%),次要不合组患者65例(16.5%),主次均不合组患者41例(10.5%)],血型相合组患者210例(53.4%)。 结果除6例患者植入失败外,其余387例患者allo-HSCT后均获得造血重建。主要不合组患者红细胞植入时间迟于相合组、次要不合组患者(均0.001)。主要不合组患者及主次均不合组患者纯红细胞再生障碍性贫血(PRCA)发生率均显著高于次要不合组患者及相合组患者(分别为11.7%、9.8%、0%和1.0%,p均0.01),且此两组患者移植后红细胞输注量亦显著高于相合组患者(p=0.003、p=0.004)。Logistic回归多因素分析显示allo-HSCT后14d凝集素滴度水平高是发生PRCA的独立危险因素(OR值=1.033,95%CI[1.005-1.062], p=0.019)。血型不合组患者于移植后77(17-300)d血型成功转变为供者型。主要不合组、次要不合组、主次均不合组患者和相合组患者移植后II-IV度急性移植物抗宿主病(aGVHD)的累积发生率、慢性移植物抗宿主病(cGVHD)的累积发生率、4年总生存率(OS)、复发率和非复发死亡率均无显著差异(p=0.628,p=0.467,p=0.720,p=0.257和p=0.111)。Logistic回归多因素分析显示移植后发生Ⅱ-Ⅳ度aGVHD(p=0.005)和移植后红细胞的输注量大(p=0.022)是影响OS的危险因素。 结论供受者ABO血型不合对allo-HSCT疗效无明显影响,但供受者ABO血型主要不合及主次均不合患者allo-HSCT后易发生PRCA,allo-HSCT后14d凝集素滴度水平高是allo-HSCT后发生PRCA的独立危险因素。
[Abstract]:Objective to study the effect of ABO blood group incompatibility on allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods from January 2007 to December 2012, 393 patients with allo-HSCT in our hospital were analyzed. Of them, 264 (67.2%) were sibling donor matched (IRD) allo-HSCT, 26 (6.6%) were sibling donor mismatched (MRD) allo-HSCT, 54 (13.7%) were unrelated to (IUD) allo-HSCT, 24 (6.1%) were unrelated to (MUD) allo-HSCT, 22 (5.6%) were hemiploidy allo-HSCT, and (UBC) allo-HSCT was cord blood. Of the 3 patients (0.8%), 183 (46.6%) had ABO blood group incompatibility (46.6%) [77 cases (19.6%) were main incompatibility group, 65 cases (16.5%) were minor incompatibility group, 41 cases (10.5%) were primary and secondary incompatibility group], 210 cases (53.4%) in blood group. Results Hematopoietic reconstitution was achieved in 387 patients after allo-HSCT except 6 cases failed. The time of erythrocyte implantation was later in the main group than in the concomitant group and in the minor group (all 0.001). The incidence of pure red blood cell aplastic anemia (PRCA) was significantly higher in the patients with primary and secondary malaemia than in the patients with minor dysplasia and in the concomitant group (11.79.80% and 1.0%, respectively), and the incidence of red blood cell transplantation in these two groups was significantly higher than that in the control group (P < 0.01). The volume of infusion was also significantly higher than that of the matched group (p0.003 / p0.004). Logistic regression multivariate analysis showed that the high level of lectin titer 14 days after allo-HSCT was an independent risk factor for the occurrence of PRCA (OR = 1.033 / 95 CI [1.005-1.062], p = 0.019). The blood group was successfully converted to donor type 77 (17-300) d after transplantation. The cumulative incidence of II-IV grade acute graft-versus-host disease (aGVHD) after transplantation in patients with major, secondary, primary and secondary mismatch and concomitant group. There was no significant difference in the cumulative incidence of chronic graft-versus-host disease (cGVHD), the 4-year overall survival rate of (OS), and the non-recurrent mortality (p0.628). Logistic regression analysis showed that there was no significant difference in the incidence of aGVHD 鈪，
本文编号：2176276
[Abstract]:Objective to study the effect of ABO blood group incompatibility on allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods from January 2007 to December 2012, 393 patients with allo-HSCT in our hospital were analyzed. Of them, 264 (67.2%) were sibling donor matched (IRD) allo-HSCT, 26 (6.6%) were sibling donor mismatched (MRD) allo-HSCT, 54 (13.7%) were unrelated to (IUD) allo-HSCT, 24 (6.1%) were unrelated to (MUD) allo-HSCT, 22 (5.6%) were hemiploidy allo-HSCT, and (UBC) allo-HSCT was cord blood. Of the 3 patients (0.8%), 183 (46.6%) had ABO blood group incompatibility (46.6%) [77 cases (19.6%) were main incompatibility group, 65 cases (16.5%) were minor incompatibility group, 41 cases (10.5%) were primary and secondary incompatibility group], 210 cases (53.4%) in blood group. Results Hematopoietic reconstitution was achieved in 387 patients after allo-HSCT except 6 cases failed. The time of erythrocyte implantation was later in the main group than in the concomitant group and in the minor group (all 0.001). The incidence of pure red blood cell aplastic anemia (PRCA) was significantly higher in the patients with primary and secondary malaemia than in the patients with minor dysplasia and in the concomitant group (11.79.80% and 1.0%, respectively), and the incidence of red blood cell transplantation in these two groups was significantly higher than that in the control group (P < 0.01). The volume of infusion was also significantly higher than that of the matched group (p0.003 / p0.004). Logistic regression multivariate analysis showed that the high level of lectin titer 14 days after allo-HSCT was an independent risk factor for the occurrence of PRCA (OR = 1.033 / 95 CI [1.005-1.062], p = 0.019). The blood group was successfully converted to donor type 77 (17-300) d after transplantation. The cumulative incidence of II-IV grade acute graft-versus-host disease (aGVHD) after transplantation in patients with major, secondary, primary and secondary mismatch and concomitant group. There was no significant difference in the cumulative incidence of chronic graft-versus-host disease (cGVHD), the 4-year overall survival rate of (OS), and the non-recurrent mortality (p0.628). Logistic regression analysis showed that there was no significant difference in the incidence of aGVHD 鈪，
本文编号：2176276
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