背景:异基因造血干细胞移植(alloHSCT)是用于治疗多种严重疾病的实质性治疗程序。尽管在治疗和支持治疗方面取得了进展,alloHSCT仍然具有相当大的死亡风险,主要由移植物抗宿主病(GvHD)引起。我们的回顾性分析旨在确定HLA相同的同胞alloHSCT中影响总体生存率和GvHD发展的因素。我们分析了病人和捐献者的年龄,AB0兼容性,受体-捐赠者性别匹配,干细胞来源,从诊断到AlloHSCT的时间,调理方案类型,GvHD预防,和复发。
方法:我们的研究包括96名患者(54名男性,42名女性),接受HLA相同的同胞alloHSCT。中位随访时间为64.5个月(范围1-218个月),受者和捐献者的中位年龄均为34岁.恶性血液病是alloHSCT最常见的适应症。
结果:GvHD及其并发症的死亡人数最高(N=24;46.2%),其次是复发(N=18;34.6%)。急性GvHD在30例患者中发生(31.3%),而慢性GvHD发生在25例患者(26.0%),共有45例患者(46.9%)经历GvHD。与其他患者相比,男性受者和女性供者的总生存率明显更差(P=0.01;HR=2.33)。与1年后移植的患者相比,在诊断后1年内移植的患者的总体生存率更高(P=0.03;HR=1.93)。关于对急性GvHD的影响,没有因素达到统计学意义,慢性GvHD,或整体GvHD。
结论:我们证实了性别不匹配,特别是在女性捐赠者和男性接受者的情况下,显着负面影响alloHSCT后的总生存率。此外,当诊断和alloHSCT之间的间隔时间超过1年时,总生存期显著缩短.
BACKGROUND: Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a substantial therapeutic procedure for the treatment of a wide spectrum of severe diseases. Despite advancements in treatment and supportive care, alloHSCT still carries a considerable mortality risk, primarily caused by graft-versus-host disease (GvHD). Our retrospective analysis aimed to identify the factors influencing overall survival and GvHD development in HLA-identical sibling alloHSCT. We have analyzed patients\' and donors\' age, AB0 compatibility, recipient-donor gender match, stem cell source, time from the diagnosis to alloHSCT, conditioning regimen type, GvHD prophylaxis, and relapse.
METHODS: Our study included 96 patients (54 male, 42 female) who underwent HLA-identical sibling alloHSCT. The median follow-up was 64.5 months (range 1-218 months), and the median age of both recipients and donors was 34 years. Malignant hematological diseases were the most common indications for alloHSCT.
RESULTS: GvHD and its complications accounted for the highest number of deaths (N = 24; 46.2%), followed by relapse (N = 18; 34.6%). Acute GvHD developed in 30 patients (31.3%), while chronic GvHD occurred in 25 patients (26.0%), resulting in a total of 45 patients (46.9%) experiencing GvHD. Male recipients with female donors had significantly worse overall survival compared to other patients (P = 0.01; HR = 2.33). Overall survival was better in patients transplanted within 1 year from the diagnosis compared to those transplanted after 1 year (P = 0.03; HR = 1.93). No factor reached statistical significance regarding the impact on acute GvHD, chronic GvHD, or overall GvHD.
CONCLUSIONS: We confirmed that sex mismatch, specifically in the case of a female donor and a male recipient, significantly negatively affects overall survival after alloHSCT. Additionally, overall survival is significantly shorter when the interval between the diagnosis and alloHSCT exceeds one year.