南方医科大学学报2011，Vol.31Issue(3)：438-442,5.
HLA配型对慢性粒细胞白血病异基因造血干细胞移植效果的分析
Impact of HLA compatibility on the outcome of allogeneic hematopoietic stem cell transplantation for chronic myeloid leukemia
摘要
Abstract
To analyze the influence of HLA compatibility on the outcome of allogeneic hematopoietic stemcell transplantation (allo-HSCT) in patients with chronic myeloid leukemia (CML). Methods This retrospective study involved 121 CML patients including 90 in chronic phase, 8 in accelerated phase and 23 with blast crisis. Of these patients, 85 received related and 36 had unrelated donor allo-HSCT. The conditioning regimens included total body irradiation with cyclophosphamide in 37 patients, and modified BUCY protocol in 84 patients. Cyclosporine A (CsA) and methotrexate (MTX) were used for graft-versus-host disease (GVHD) prophylaxis in patients undergoing HLA-matched sibling donoT transplants. CsA, MTX, antihuman thymocyte globulin and mycophertolate were used in all the patients undergoing HLA-mismatched related donor and unrelated donor transplants. The prognostic factors of CML were evaluated using Cox regression and the cumulative overall survival and the disease-free survival were estimated using Kaplan and Meier survival analysis model. Results The incidence of Ⅱ-FV acute GVHD was 26.1% in HLA-matched and 53.3% in HLA-mismatched cases (P=0.006), with a 5-year cumulative incidence of chronic GVHD of 47.4% and 49.6%, respectively (P=0.947). The 5-year cumulative incidences of disease relapse was 16.7% in the total patients, with a 5-year cumulative overall survival (OS) of 70.5% and disease-free survival (DFS) of 63.4%. The 5-yearOS was 78.2% in HLA-matched cases, as compared with 47.6% in HLA-mismatched cases. Multivariate analysis with Cox regression model identified HLA mismatch, Ⅱ-Ⅳ acute GVHD, and advanced phase as die risk factors affecting the OS. Conclusion HLA mismatch can significantly increase the incidence of Ⅱ-Ⅳ acute GVHD following allo-HSCT and decrease the long-term survival rate, which is not related to the donor source.关键词
慢性粒细胞白血病/异基因造血干细胞移植/HLA配型Key words
chronic myeloid leukemia/ stem cell transplantation/ graft-versus-host disease/ HLA typing分类
医药卫生引用本文复制引用
张钰,刘启发,陈银葵,范志平,徐丹,赵捷,江千里,凌奕文,刘灿,孙竟..HLA配型对慢性粒细胞白血病异基因造血干细胞移植效果的分析[J].南方医科大学学报,2011,31(3):438-442,5.基金项目
国家自然科学基金(30971300) （30971300）
国家863计划(2006AA02Z4A0) （2006AA02Z4A0）
广东省科技计划项目(2009A030200007) （2009A030200007）
