【摘要】：目的研究ABO血型不合對異基因造血干細(xì)胞移植(allo-HSCT)療效的影響。 方法對2007年1月至2012年12月在我院行allo-HSCT的393例血液病患者的結(jié)果進(jìn)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%),無關(guān)供者相合(IUD) allo-HSCT患者54例(13.7%),無關(guān)供者不相合(MUD) allo-HSCT患者24例(6.1%),半倍體allo-HSCT患者22例(5.6%),臍帶血(UBC) allo-HSCT患者3例(0.8%)。393例患者中ABO血型不合者183例(46.6%)[主要不合組患者77例(19.6%),次要不合組患者65例(16.5%),主次均不合組患者41例(10.5%)],血型相合組患者210例(53.4%)。 結(jié)果除6例患者植入失敗外,其余387例患者allo-HSCT后均獲得造血重建。主要不合組患者紅細(xì)胞植入時(shí)間遲于相合組、次要不合組患者(均0.001)。主要不合組患者及主次均不合組患者純紅細(xì)胞再生障礙性貧血(PRCA)發(fā)生率均顯著高于次要不合組患者及相合組患者(分別為11.7%、9.8%、0%和1.0%,p均0.01),且此兩組患者移植后紅細(xì)胞輸注量亦顯著高于相合組患者(p=0.003、p=0.004)。Logistic回歸多因素分析顯示allo-HSCT后14d凝集素滴度水平高是發(fā)生PRCA的獨(dú)立危險(xiǎn)因素(OR值=1.033,95%CI[1.005-1.062], p=0.019)。血型不合組患者于移植后77(17-300)d血型成功轉(zhuǎn)變?yōu)楣┱咝汀Ｖ饕缓辖M、次要不合組、主次均不合組患者和相合組患者移植后II-IV度急性移植物抗宿主病(aGVHD)的累積發(fā)生率、慢性移植物抗宿主病(cGVHD)的累積發(fā)生率、4年總生存率(OS)、復(fù)發(fā)率和非復(fù)發(fā)死亡率均無顯著差異(p=0.628,p=0.467,p=0.720,p=0.257和p=0.111)。Logistic回歸多因素分析顯示移植后發(fā)生Ⅱ-Ⅳ度aGVHD(p=0.005)和移植后紅細(xì)胞的輸注量大(p=0.022)是影響OS的危險(xiǎn)因素。 結(jié)論供受者ABO血型不合對allo-HSCT療效無明顯影響,但供受者ABO血型主要不合及主次均不合患者allo-HSCT后易發(fā)生PRCA,allo-HSCT后14d凝集素滴度水平高是allo-HSCT后發(fā)生PRCA的獨(dú)立危險(xiǎn)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，

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