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移植前铁过载对重型再生障碍性贫血异基因造血干细胞移植疗效的影响

潘田中 汤宝林 朱小玉 刘会兰 宋闿迪 皖湘 姚雯 孙光宇 汪健 孙自敏

潘田中, 汤宝林, 朱小玉, 等. 移植前铁过载对重型再生障碍性贫血异基因造血干细胞移植疗效的影响[J]. 器官移植, 2020, 11(2): 234-239. doi: 10.3969/j.issn.1674-7445.2020.02.008
引用本文: 潘田中, 汤宝林, 朱小玉, 等. 移植前铁过载对重型再生障碍性贫血异基因造血干细胞移植疗效的影响[J]. 器官移植, 2020, 11(2): 234-239. doi: 10.3969/j.issn.1674-7445.2020.02.008
Pan Tianzhong, Tang Baolin, Zhu Xiaoyu, et al. Effect of pretransplant iron overload on clinical efficacy of allogeneic hematopoietic stem cell transplantation on severe aplastic anemia[J]. ORGAN TRANSPLANTATION, 2020, 11(2): 234-239. doi: 10.3969/j.issn.1674-7445.2020.02.008
Citation: Pan Tianzhong, Tang Baolin, Zhu Xiaoyu, et al. Effect of pretransplant iron overload on clinical efficacy of allogeneic hematopoietic stem cell transplantation on severe aplastic anemia[J]. ORGAN TRANSPLANTATION, 2020, 11(2): 234-239. doi: 10.3969/j.issn.1674-7445.2020.02.008

移植前铁过载对重型再生障碍性贫血异基因造血干细胞移植疗效的影响

doi: 10.3969/j.issn.1674-7445.2020.02.008
基金项目: 

国家自然科学基金 81470350

中央高校基本科研业务费专项资金 WK9110000001

详细信息
    作者简介:

    潘田中,男,1994年生,本科,住院医师,研究方向为脐带造血干细胞移植,Email:2275314125@qq.com

    通讯作者:

    孙自敏,女,1956年生,教授,主任医师,研究方向为脐带造血干细胞移植,Email:zmsun_vip@163.com

  • 中图分类号: R617, R556.5

Effect of pretransplant iron overload on clinical efficacy of allogeneic hematopoietic stem cell transplantation on severe aplastic anemia

More Information
  • 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。

     

  • 图  1  allo-HSCT受者的生存曲线

    Figure  1.  Survival curves of allo-HSCT recipients

    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
    HR(95% CI P HR(95% CI P
    性别 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 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 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。
    下载: 导出CSV

    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
    HR(95% CI) P HR (95% CI) P
    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 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。
    下载: 导出CSV
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出版历程
  • 收稿日期:  2019-12-17
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2020-03-15

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