摘要
目的探讨预处理方案中增加抗胸腺细胞球蛋白(ATG)对异基因造血干细胞移植(allo-HSCT)患者移植物抗宿主病(GVHD)的预防和生活质量的影响。方法回顾性分析2006年7月至2012年9月东南大学附属中大医院血液科收治的行allo-HSCT的72例患者,按预处理方案中是否有ATG分为ATG组(38例)和对照组(34例)。移植后定期监测血象、骨髓细胞遗传学(染色体核型分析)、STR微卫星检测等进行嵌合分析。并采用KPS评分系统及欧洲癌症研究与治疗组织核心生活质量问卷(EORTC QLQ C30,version 1.0)进行生活质量评价。结果 72例达到完全稳定的供者植入,ATG组患者急性GVHD总发生率为21.1%,对照组急性GVHD总发生率为52.9%(P=0.007)。ATG组与对照组慢性GVHD总发生率分别为15.8%和50.0%(P=0.002)。Karnofsky评分>80分的患者在ATG组占68.4%,对照组占29.4%(P=0.002)。移植后两组患者机会性感染的发生率差异有统计学意义(57.9%对26.5%,P=0.009),ATG组患者与非ATG组患者的3年总生存(OS)率分别为65.8%和55.9%,差异无统计学意义(P=0.470)。结论预处理方案中加入ATG不仅能降低急、慢性GVHD的发生率,而且能改善alloHSCT患者的生活质量,但两者的总生存率差异无统计学意义。
Objective To explore the effect of adding anti-human thymocyte globulin （ATG） on GVHD prophylaxis and its effect on the quality of life （QoL） of 72 hemopathic patients undergoing allo-HSCT. Methods We retrospectively analyzed the outcomes of 72 consecutive patients undergoing allo-HSCT, including 38 patients who received ATG regimen （ATG group） and 34 patients who received neither ATG regimen（ control group）. After transplantation ,blood was regularly moni-tored, and karyotype anlysis and chimeric analysis were conducted. And KPS score system and European cancer research and treatment organizations core life quality questionnaire （ EORTC QLQ C30, version 1.0） were used to assess quality of life. Results Seventy-two patients in this study achieved trilineage engraftment with full-donor chimerism. The cumulative incidence of acute GVHD （aGVHD） was lower in ATG group than that in control group （21.1% vs 52. 9% ,P = O. 007）, and the cumulative incidence of chronic GVHD （eGVHD） was 15.8% for patients with ATG and 50. 0% for patients with-out ATG （ P = 0. 002）. Notably, the proportion of patients with Karnofsky scores of 〉 80 was 68.4% in the patients with ATG, and 29.4% in the patients without ATG （P = 0. 002）. Furthermore, the cumulative incidence of patients with oppor- tunistic infection was significantly different in both groups post transplantation （57.9% vs 26. 5 % ,P = 0. 009）. CConclu-sion Additional usage of ATG can not only decrease the occurrence of aGVHD and eGVHD, but also improve QoL of pa-tients after allo-HSCT without affecting overall survival.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2013年第9期712-716,共5页
Chinese Journal of Practical Internal Medicine
基金
江苏省医学重点学科资助(2011-12)
关键词
造血干细胞移植
异基因
生活质量
抗胸腺细胞球蛋白
移植物抗宿主病
allogeneie hematopoietic stem cell transplantation
quality of life
antihuman thymocyte globulin
graft-versus-hostdisease
