难治复发急性白血病患者造血干细胞移植后感染相关死亡的分析

摘要

目的 探讨难治复发急性白血病患者接受异基因造血干细胞移植(allo-HSCT)后感染相关死亡(IRM)的特点.方法 回顾分析127例接受allo-HSCT的难治复发急性白血病患者的临床资料,统计感染相关死亡情况并分析危险因素.结果 观察期内67例死亡.5年总生存率为(35.2±5.3)％,无病生存率为(30.8±5.6)％.28.3％ (36/127)患者发生感染相关死亡.Ⅱ～Ⅳ°aGVHD (P=0.049,OR=3.017)和移植后IFI(P=0.032,OR=3.223)是IRM的独立危险因素.结论 感染作为移植相关死亡的主要原因,相对于标危患者,在难治复发患者中占更高的比例.更多的关注严重GVHD后感染的预防和治疗力度是目前减少IRM的主要措施.%Objective To investigate infection-related mortality (IRM) after allogeneic hematopoietic stem cell transplantation in patients with refractory /relapse acute leukemia. Methods We conducted a retrospective analysis of 127 patients with refractory/ relapse acute leukemia and investigated the incidence, causes and risk factors of IRM. Results Sixty-seven of the patients died after the transplantation. The 5-year overall survival and disease-free survival was (35.2±.3)% and (30.8±.6)% among these patients, respectively. IRM occurred in 28.3% (36/127) of the patients. Multivariate analysis showed that grade II-IV acute graft-versus-host diseases (aGVDH, P=0.049, OR=3.017) and post-transplant invasive fungal infection (P=0.032, OR=3.223) were independent risk factors of IRM. Conclusion As a common cause of transplant-related mortality, IRM is more frequent in cases of refractory/relapse acute leukemia than in cases with a standard risk profile, and effective prophylaxis and treatment of severe GVHD remain currently the primary measures for reducing post-transplant IRM.