Clinical Study Of Allogeneic Hematopoietic Stem Cell Transplantation For Hematological Malignancies

Objective:Firstly,to explore the effect of allogeneic hematopoietic stem cell transplantation in the treatment of malignant hematopathy and its influencing factors.Secondly,the factors affecting recurrence after allogeneic hematopoietic stem cell transplantation were discussed.Thirdly,discusses the factors affecting GVHD after allogeneic hematopoietic stem cell transplantation.Methods:A retrospective analysis was performed on 300 cases of hematopoietic stem cell transplantation due to malignant hematological diseases in a hospital from January 2010 to June 2018.SPSS 20.0 statistical software was used for statistical processing,the binary classification data was tested by chi-square test,the multi-classification data was tested by non-parametric test,the OS and DFS of patients were calculated by kaplan-meier method,the comparison between groups was tested by Log rank test,and the multi-factor analysis affecting OS and DFS was analyzed by Cox proportional risk regression model.P<0.05 means the difference is statistically significant.Results:Firstly,HLA-identical and haploidentical cohorts were not statistically different in the hematopoietic reconstitution rate,incidence of GVHD,posttransplant recurrence rate and disease-free survival(DFS).However,between the haploidentical and identical transplantation group,the time of platelet implantation was longer,the recurrence-related mortality was higher and the overall survival rate(OS)was lower.Secondly,univariate analyses showed that non-remission before transplantation,high-risk,grade III,IV aGVHD were risk factors for OS in both two groups(P<0.05).More than 40 years old at the time of transplantation and unrelated donors were rnsk factors for OS in haploidentical transplantation group(P<0.05).Thirdly,multivariate analysis showed that non-remission before transplantation,grade Ⅲ,ⅣaGVHD were independent prognostic indictors for OS with relative risk(RR)of 4.4(95%CI,1.5-13.4),9.3(95%CI,2.3-37.0),11.0(95%CI,3.2-37.3)(P<0.05)in identical transplantation group.Unrelated donor,high-risk group,gradeIVaGVHD were independent prognostic indictors for OS with relative risk(RR)of 7.4(95%CI,2.3-23.1),2.4(95%CI,1.3-4.5),4.1(95%CI,1.6-10.5)(P<0.05)in haploidentical transplantation group.Fourthly,univariate analysis showed that ALL,high risk,<20 years old and>40 years oldat the time of transplantation were rnsk factors for recurrence after transplantation(P<0.05).Multivariate analysis showed that ALL and high risk were independent factors affecting post-transplant DFS,with relative risks of 2.7(95%CI,1.6-4.5)and 3.2(95%CI,2.0-5.1)(P<0.05),respectively.Fifthly,the incidence and intensity of GVHD after transplantation were higher when the patients in high-risk or without ATG(P<0.05).Conclusion:Firstly,The comprehensive curative effect of identical transplantation is better than the haploidentical transplantation in hematological malignancies.Secondly,patients with ALL,high risk had higher recurrence rate and shorter DFS.Thirdly,the incidence and intensity of GVHD after transplantation were higher when the patients in high-risk or without ATG.