Effect of pretransplant iron overload on clinical efficacy of allogeneic hematopoietic stem cell transplantation on severe aplastic anemia
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摘要:
目的 研究移植前铁过载对重型再生障碍性贫血(SAA)患者异基因造血干细胞移植(allo-HSCT)疗效的影响。 方法 回顾性分析行首次allo-HSCT的80例SAA受者临床资料。根据有否铁过载,将受者分为铁过载组(20例)和无铁过载组(60例)。比较两组间受者移植后植入率、并发症发生情况及预后情况;采用Cox比例风险回归模型分析受者2年总生存率(OS)和180 d移植相关病死率(TRM)的影响因素。 结果 无铁过载组的中性粒细胞植入率为98%(59/60),明显高于铁过载组的75%(15/20)(P < 0.05)。无铁过载组的血小板植入率为90%(54/60),明显高于铁过载组的65%(13/20)(P < 0.05)。无铁过载组血流感染发生率为23%(14/60),明显低于铁过载组的40%(8/20)(P < 0.05)。无铁过载组受者术后180 d TRM为17%,明显低于铁过载组的45%(P < 0.05)。无铁过载组受者术后1、2年OS分别为82%、80%,均高于铁过载组的50%、44%(均为P < 0.05)。是否有铁过载是受者的OS和TRM的独立危险因素(均为P < 0.05)。 结论 铁过载可影响SAA患者allo-HSCT移植后的OS和TRM。 -
关键词:
- 铁过载 /
- 重型再生障碍性贫血 /
- 异基因造血干细胞移植 /
- 移植相关病死率 /
- 总生存率 /
- 脐带血干细胞移植 /
- 同胞异基因造血干细胞移植
Abstract:Objective To evaluate the effect of pretransplant iron overload on the clinical efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with severe aplastic anemia (SAA). Methods Clinical data of 80 SAA recipients who underwent allo-HSCT for the first time were retrospectively analyzed. According to the incidence of iron overload, all recipients were divided into the iron overload group (n=20) and non-iron overload group (n=60). The engraftment rate, incidence of postoperative complications and clinical prognosis of the recipients afterallo-HSCT were statistically compared between two groups. The influencing factors of 2-year overall survival (OS) and 180 d transplantation related mortality (TRM) were analyzed by Cox proportional hazards regression model. Results The engraftment rate of neutrophils in the non-iron overload group was 98% (59/60), significantly higher than 75% (15/20) in the iron overload group (P < 0.05). The engraftment rate of platelet in the non-iron overload group was 90% (54/60), significantly higher than 65% (13/20) in the iron overload group (P < 0.05). The incidence rate of bloodstream infection in the non-iron overload group was 23% (14/60), remarkably lower than 40% (8/20) in the iron overload group (P < 0.05). The 180 d TRM of the recipients in the non-iron overload group was 17%, significantly lower than 45% in the iron overload group (P < 0.05). The 1- and 2-year OS of the recipients in the non-iron overload group were 82% and 80%, significantly higher than 50% and 44% in the iron overload group (both P < 0.05). Iron overload or not was an independent risk factor of the OS and TRM of the recipients (both P < 0.05). Conclusions Iron overload can affect the OS and TRM of SAA patients after allo-HSCT. -
表 1 allo-HSCT受者预后的单因素分析结果
Table 1. Univariate analysis of the prognosis of allo-HSCT recipients
因素 基线值 比较值 OS TRM HR①(95% CI②) P值 HR(95% CI) P值 性别 男 女 0.85 (0.37~1.94) 0.712 0.85 (0.34~2.08) 0.714 体质量 < 47 kg ≥47 kg 1.33 (0.58~3.03) 0.498 1.12(0.45~2.76) 0.803 年龄 < 19岁 ≥19岁 1.41 (0.62~3.21) 0.419 1.18 (0.48~2.90) 0.719 诊断至移植时间 < 142.5 d ≥142.5 d 1.79 (0.78~4.15) 0.172 1.93 (0.76~4.90) 0.167 诊断类型 SAA-Ⅰ SAA-Ⅱ 2.38 (1.05~5.40) 0.038 2.28 (0.93~5.62) 0.073 预处理方案是否含有ATG 是 否 1.54 (0.57~4.16) 0.391 1.21(0.43~3.35) 0.720 移植类型 UCBT sib-HSCT 0.95 (0.42~2.15) 0.902 0.79 (0.32~1.95) 0.616 是否有铁过载 否 是 3.58 (1.58~8.15) 0.002 3.39 (1.37~8.37) 0.008 注:①HR为风险比。
②CI为可信区间。表 2 allo-HSCT受者预后的多因素分析结果
Table 2. Multivariate analysis of the prognosis of allo-HSCT recipients
因素 基线值 比较值 OS TRM HR①(95% CI②) P值 HR (95% CI) P值 诊断至移植时间 < 142.5 d ≥142.5 d 0.39 (0.09~1.74) 0.219 0.55 (0.11~2.64) 0.462 诊断类型 SAA-Ⅰ SAA-Ⅱ 3.09 (0.86~11.11) 0.083 2.40 (0.65~8.89) 0.189 是否有铁过载 否 是 4.31 (1.55~11.99) 0.005 3.64 (1.19~11.15) 0.023 注:①HR为风险比。
②CI为可信区间。 -
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