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目的 分析单倍体与全相合造血干细胞移植治疗恶性血液系统疾病的疗效,及影响移植后生存的相关危险因素.方法 选取2011年10月至2017年7月行血缘相关异基因造血干细胞移植术的81例恶性血液病受者为研究对象,据移植方式分为单倍体移植组30例和全相合移植组51例.统计两组受者的造血重建时间、移植物抗宿主病(GVHD)发生率、总体生存率、无病存活率、复发率及非复发死亡率,并对可能影响总体存活率的危险因素进行多因素分析.结果 81例受者均植入成功.移植后100 d单倍体移植、全相合移植组的Ⅱ～ⅣaGVHD的发生率分别为56.7％、11.8％,差异具有统计学意义(P=0.000).单倍体移植、全相合移植受者移植后1年的cGVHD发生率分别为20.6％、45％,差异无统计学意义(P=0.341).单倍体移植、全相合移植受者移植后2年的总体存活率分别为63.2％、78.4％(P=0.078),2年的无病生存率分别为54.8％、66.9％(P=0.159),移植后2年的复发率分别为25.9％、22.9％(P=0.465),移植后2年的非复发死亡率分别为24％、9.5％,差异均无统计学意义(P=0.118).多因素分析结果显示,移植后复发、Ⅱ～Ⅳ度急性GVHD是影响生存率的危险因素,相对风险(RR)分别为6.671(95％ CI 2.791～15.946)、3.073(95％ CI 1.296～7.284) (P＜0.05).结论 恶性血液病受者行单倍体移植的疗效与同胞全相合移植相似,移植后复发、发生重度急性GVHD对移植后受者的长期生存具有预后意义.

Objective To compare the efficacy of haploidentical hematopoietic stem cell transplantation (HSCT) and HLA-identical transplantation for hematologic diseases,and analyze risk factors related to overall survival (OS).Methods There were 81 patients with hematological malignancies receiving Allo-HSCT from October,2011 to July,2017.The patients were divided into two groups:30 patients undergoing haploidentical HSCT and 51 cases undergoing matched sibling donor HSCT (MSD-HSCT).Implantations of hematopoietie stem cells,incidence of graft versus host disease (GVHD),OS rate,disease free survival (DFS) rate,incidence of relapse and non-relapsemortality were analyzed statistically.Multivariate analysis was used to analyze the risk factors related to OS.Results All patients achieved sustained engraftment.100 days after Allo-HSCT,thecumulative incidence for Ⅱ-Ⅳ aGVHD had no significant difference between haplo-HSCT and MSD-HSCT (56.7％ versus 11.8％,P =0.000).There was no significant difference in the 1-year cumulative incidence for cGVHD between haplo-HSCT and MSD-HSCT (20.6％ versus 45％,P =0.341).The 2-year OS rate in patients receiving haplo-HSCT and MSD-HSCT was 63.2％ and 78.4％ respectively (P =0.078).The 2-year DFS rate in patients receiving haplo-HSCT and MSD-HSCT was 54.8％ and 66.9％ respectively (P=0.159).The 2-year relapse and non-relapse-mortality rate in patients receiving haplo-HSCT and MSD-HSCT was 25.9％ and 24％,and 22.9％ and 9.5％ respectively.There were no statistically significant differences in relapse rate and mortality between two groups (P =0.465,0.118).Multivariate analysis showed that relapse and Ⅱ-Ⅳ aGVHD were independent prognostic indictors for OS with relative risk 6.671 (95％ CI 2.791-15.946) and 3.073 (95％ CI 1.296 ～ 7.284) (P ＜ 0.05).Conclusion The therapeutic effects of haploidentical transplantation were similar to those of HLA-identical sibling transplantation.Relapse and Ⅱ-Ⅳ aGVHD after transplantation have prognostic significance for the long-term survival of transplant patients.