Analysis of Relapse after Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Hematological Malignancies: A Single-center Study.
10.19746/j.cnki.issn.1009-2137.2022.04.042
- Author:
Jia-Pei LU
1
;
Shu-Peng WEN
1
;
Fu-Xu WANG
1
;
Shu-Hui LI
1
;
Zhi-Yun NIU
1
;
Ying WANG
1
;
Zi-Wei ZHOU
1
;
Zheng XU
1
;
Zhen-Zhen WANG
1
;
Xue-Jun ZHANG
2
Author Information
1. Department of Hematology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China.
2. Department of Hematology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China,E-mail: zhxjhbmu126.com.
- Publication Type:Journal Article
- Keywords:
NK;
allogeneic hematopoietic stem cell transplantation;
hematological malignancy;
prognosis;
relapse
- MeSH:
Graft vs Host Disease/prevention & control*;
Hematologic Neoplasms/therapy*;
Hematopoietic Stem Cell Transplantation;
Humans;
Neoplasm Recurrence, Local;
Retrospective Studies;
Siblings
- From:
Journal of Experimental Hematology
2022;30(4):1238-1243
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To analyze the survival, prognostic factors, and prevention of relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with hematological malignancies, and explore the relationship between immune reconstruction, loss of human leukocyte antigen (HLA-loss) and relapse after transplantation.
METHODS:From July 2012 to June 2020, 47 patients with hematological malignancies who relapsed after allo-HSCT were retrospectively analyzed, including 20 cases undergoing matched-sibling donor transplantation (MSD), 26 cases undergoing haploidentical transplantation (HID), and 1 case undergoing matched-unrelated donor transplantation (MUD). Multivariate analysis was used to analyze the risk factors related to post-relapse overall survival (PROS).
RESULTS:All the 47 patients were implanted successfully. The cumulative incidence of grade Ⅱ-Ⅳ, Ⅲ/Ⅳ acute graft-versus-host disease (aGVHD) and chronic GVHD (cGVHD) was 40.4%, 10.6%, and 31.9%, respectively. The incidence of grade Ⅱ-Ⅳ and Ⅲ/Ⅳ aGVHD in HID group was 42.3% and 11.5%, while in MD group was 38.1% and 9.5% (P=0.579, P=1.000), and the incidence of cGVHD in the two groups was 34.6% and 28.6% (P=0.659). The PROS of patients with NK cell absolute count > 190 cells/μl 30 days after transplantation was higher than that of patients with NK cell absolute count ≤190 cells/μl (P=0.021). The 1-year and 3-year PROS of all the patients was 68.1% and 28.4%, respectively, while in the HID group was 78.9% and 40.3%, in the MD group was 54.4% and 14% (P=0.048). Multivariate analysis showed that grade Ⅱ-Ⅳ aGVHD and time of relapse < 3 months were independent risk factors of PROS (P<0.05).
CONCLUSION:The therapeutic effect of haploidentical transplantation in patients with relapsed hematological malignancies after allo-HSCT is better than that of matched donor transplantation. The high absolute count of NK cells 30 days after transplantation can increase PROS. Grade Ⅱ-Ⅳ aGVHD and time of relapse < 3 months have prognostic significance for long-term survival of patients with relapsed hematological malignancies after transplantation.
