不同方式异基因造血干细胞移植治疗63例重型再生障碍性贫血患者的预后比较

OBJECTIVE: To compare the differences between hematopoietic reconstitution and long-term prognosis of patients with severe aplastic anemia (SAA) after HLA-matched sibling donor hematopoietic stem cell transplantation (MSD-HSCT), Haploidentical HSCT (Haplo-HSCT), unrelated donor allogeneic HSCT (UD-HSCT) and umbilical cord blood HSCT (UCB-HSCT). METHODS: In this retrospective study, 63 patients with SAA who received HSCT in the First Affiliated Hospital of Soochow University between May 2008 and December 2013 were enrolled. The subjects were divided into 4 groups according to the transplantation types. The hematopoietic reconstitution, the incidence of acute graft-versus-host disease (aGVHD) and 5-year survival rate after transplantation were compared. RESULTS: All 53 subjects who received MSD-HSCT, Haplo-HSCT and UD-HSCT achieved hematopoietic reconstitution. Of them, the recovery of neutrophil and platelet were not significantly different (P<0.05). Patients receiving UCB-HSCT had delayed recovery of hematopoiesis, and a significantly reduced reconstruction rate, when compared with those in the other 3 groups (P<0.01). However, 4 patients undergoing UCB-HSCT presented with autologous hematopoiesis, a period of time after the failure of hematopoietic reconstitution. The expected 5-year survival rates after MSD-HSCT, Haplo-HSCT, UD-HSCT and UCB-HSCT were 70.0%, 81.0%, 88.9% and 77.8%, respectively (P>0.05). CONCLUSION: MSD-HSCT, Haplo-HSCT and UD-HSCT had no statistically significance in terms of hematopoietic reconstitution or prognosis. Although hematopoietic reconstitution of UCB-HSCT was lower than other transplantation types, but no significant difference in overall prognosis. So if HLA-matched sibling donor is not available, SAA patients can choose Haplo-HSCT, UD-HSCT or UCB-HSCT with comparable efficacy to MSD-HSCT, as an alternative therapy.