二次异基因造血干细胞移植治疗70例移植后复发恶性血液病患者的疗效及安全性

OBJECTIVE: To investigate the role of donor change in the second hematopoietic stem cell transplantation (HSCT2) for hematological relapse of malignant hematology after the first transplantation (HSCT1). METHODS: We retrospectively analyzed patients with relapsed hematological malignancies who received HSCT2 at our single center between Mar 1998 and Dec 2020. A total of 70 patients were enrolled [49 males and 21 females; median age, 31.5 (3–61) yr]. RESULTS: Forty-nine male and 21 female patients were enrolled in the trial. At the time of HSCT2, the median age was 31.5 (3–61) years old. Thirty-one patients were diagnosed with acute myeloid leukemia, 23 patients with ALL, and 16 patients with MDS or other malignant hematology disease. Thirty patients had HSCT2 with donor change, and 40 patients underwent HSCT2 without donor change. The median relapse time after HSCT1 was 245.5 (26–2 905) days. After HSCT2, 70 patients had neutrophil engraftment, and 62 (88.6％) had platelet engraftment. The cumulative incidence of platelet engraftment was (93.1±4.7)％ in patients with donor change and (86.0±5.7)％ in patients without donor change (P＝0.636). The cumulative incidence of CMV infection in patients with and without donor change was (64.0±10.3)％ and (37.0±7.8)％ (P＝0.053), respectively. The cumulative incidence of grade Ⅱ–Ⅳ acute graft versus host disease was (19.4±7.9)％ vs (31.3±7.5)％, respectively (P＝0.227). The cumulative incidence of TRM 100-day post HSCT2 was (9.2±5.1)％ vs (6.7±4.6)％ (P＝0.648), and the cumulative incidence of chronic graft versus host disease at 1-yr post-HSCT2 was (36.7±11.4)％ versus (65.6±9.1)％ (P＝0.031). With a median follow-up of 767 (271–4 936) days, 38 patients had complete remission (CR), and three patients had persistent disease. The CR rate was 92.7％. The cumulative incidences of overall survival (OS) and disease-free survival (DFS) 2 yr after HSCT2 were 25.8％ and 23.7％, respectively. The cumulative incidence of relapse, OS, and DFS was (52.6±11.6)％ vs (62.4±11.3)％ (P＝0.423), (28.3±8.6)％ vs (23.8±7.5)％ (P＝0.643), and (28.3±8.6)％ vs (22.3±7.7)％ (P＝0.787), respectively, in patients with changed donor compared with patients with the original donor. Relapses within 6 months post-HSCT1 and with persistent disease before HSCT2 were risk factors for OS, DFS, and CIR. Disease status before HSCT2 and early relapse (within 6 months post-HSCT1) was an independent risk factor for OS, DFS, and CIR post-HSCT2. CONCLUSION: Our findings indicate that changing donors did not affect the clinical outcome of HSCT2.