Analysis Of Risk Factors Of Acute Graft-versus-host Disease After Allogeneic Hematopoietic Stem Cell Transplantation In Acute Leukemia Patients

BackgroundAllogenetic hematopoietic stem cell transplantation(allo-HSCT)is one of the important methods to cure acute leukemia(AL).Although transplantation technology is improving,the occurrence of graft versus host disease(GVHD)is still the most important and serious complication,especially acute GVHDwhich affects the effect of allo-HSCT and is also one of the major reasons for non-relapse mortality(NRM)after transplantation.At present,the diagnosis of acute GVHD is mainly dependent on the clinical symptoms of involved target organs,and the lack of specificity of clinical manifestations.It is difficult to distinguish from side effects of drugs and infection in the early stages of disease.Therefore,it is important to find biomarkers or risk factors that can diagnose or predict the occurrence of acute GVHD before the occurrence of clinical symptoms,which is essential to reduce the incidence of acute GVHD and increase the overall survival rate after transplantation.ObjectiveTo investigate the risk factors of acute GVHD after allo-HSCT in acute leukemia patients,and to provide more evidence for early prediction of acute GVHD.Methods:A total of 103 acute leukemia patients receiving allo-HSCT in the first Affiliated Hospital of Zhengzhou University from January 2012 to September 2016 were enrolled.The HLA-matched group adopted "improved BU/CY" regimen,the HLA-mismatched group adopted "improved BU/CY + ATG" regimen."CsA,MMF and short-term MTX " regimen were used to prevent the occurrence of acute GVHD.The levels of serum ?2-microglobulin(?2-MG),lactate dehydrogenase(LDH),albumin concentration,co-infection before transplantation,hematopoietic stem cell transplantation comorbidities indexacute(HCT-CI)and other factors were analyzed to investigate the effection on acute GVHD in AL patients receiving allo-HSCT.Results:Among the 103 patients,36 cases had acute GVHD(34.95%),A total of 54 times acute GVHD occurred,of which 27 were skin(50%),of which 18 were gastrointestinal(33.33%),of which 9 were liver(16.67%).The incidence of acute GVHD was 60.47%(26/43)in The HLA-matched group and it was 16.67%(10/60)in the HLA-mismatched group.The incidence of acute GVHD in the HLA-matched group is higher than that in the HLA-mismatched group(P<0.001).The incidence of acute GVHD in acute T lymphocytic leukemia(T-ALL)patients was 75%(9/12),higher than that in acute acute lymphoblastic leukemia(B-ALL)which was 34.15%(14/41))and in acute myeloid Leukemia(AML)group which was 26%(13/50)(P=0.008).The ANC deficiency in the transplant day group was 45.10%(23/51)and The non-ANC deficiency group was 25%(13/52),(P=0.04).The biochemical index of beta2-MG concentration,LDH level,and albumin concentrations,ANC implantation time,mononuclear cell(MNC)count,CD34 positive cell count(CD34+),infection before transplantation,hematopoietic stem cell transplantation co-morbidity(HCT-CI),sex,age,blood type difference and gender difference between recipient and donor were not statistically significant(P> 0.05).The factors of P <0.1: AL type,HLA type,neutrophils count in the transplant day,albumin concentration,CD34 +count included Logistic multivariate regression analysis,which showed that T-ALLgroup and the haploid group were more likely to occur acute GVHD(P < 0.05).COX regression analysis showed that the median leukemia free survival of acute GVHD in0-? group was 22 months(3-49),which is longer than that of the ?-? acute GVHD group(P=0.023).The median survival of acute GVHD in ?-? group was8 months(2-40).Conclusion:1.Acute GVHD of the skin type occurs more commonly,followed by gastrointestinal type,liver type.2.Haploid group,T-ALL group patients are more prone to occur acute GVHD,it will be essensial to strengthen prevention to reduce the incidence of acute GVHD.3.The levels of serum ?2-MG,LDH,albumin concentration,co-infection before transplantation,HCT-CI may have no relation to the occurrence of acute GVHD after allo-HSCT with AL patients.4.The occurrence of acute GVHD in ?-? grade affected the median leukemia free survival time of leukemia patients after transplantation.