| Objective:To evaluate the clinical efficacy and its prognosis of hematopoietic stem cell transplantation(HSCT)in hematologic diseases.Methods:Retrospectively analyze the clinical data of]04 patients with various hematologic diseases who received HSCT from January 2003 to December 2016.Among the 104 patients,40 patients received autologous hematopoietic stem cell transplantation(auto-HSCT),including 4 with acute lymphoblastic leukemia(ALL),23 with acute myeloid leukemia(AML),3 with multiple myeloma(MM),2 with hodgkin lymphoma(HL),8 with(non-hodgkin's lymphoma,NHL);the rest 64 patients received allogeneic hematopoietic stem cell transplantation(allo-HSCT),including 16 with ALL,14 with AML,8 with myelodysplastic syndrome(MDS),1 with HL,17 with chronic myelogenous leukemia(CML),8 with severe aplastic anemia(SAA).Among the 64 allo-HSCT patients,3 ALL and 2 MDS patients received umbilical cord blood hematopoietic stem cell transplantation(UBT).Kaplan-Meier curve was used to analyze 3 years overall survival(OS),3 years disease-free survival(DFS),5 years OS and 5 years DFS of HSCT patients.Log-Rank was used for the comparison between the two groups.SPSS20.0 software was used to analyse and P<0.05 was considered statistically significant.Results:1?Implanting:Of all the 104 patients,there were 3 patients including 2 allo-HSCT patients and 1 auto-HSCT patient whose hematopoietic reconstitution was failed.Hematopoietic reconstitution of the rest 101 patients was successful.The mean number of the infused CD34+ cells was 3.34×106/kg.The average time for neutrophil implanting and platelet implanting was 11 d and 13d,respectively.2?Complication:The transplantation related complications rate of auto-HSCT was 12.5%(5/40)and transplantation related mortality was 5%(2/40);the transplantation related complications of allo-HSCT was 29.7%(19/64)and transplantation related mortality was 23.4%(15/64);graft versus host disease(GVHD)of allo-HSCT was 17.2%(11/64),including 4 patients with I° skin GVHD,3 with ?° skin GVHD,3 with ?°skin and intestinal tract GVHD and 1 with ?° intestinal tract GVHD.The median follow-up time was 16 month(0-158 month).The recurrence and mortality rate was 7.5%(3/40)and 27.5%(11/40)respectively in auto-HSCT,while in allo-HSCT,the recurrence and mortality rate was 1.6%(1/64)and 50.0%(32/64).3?Survival analysis:The Kaplan-Meier curve showed that 3 years OS of auto-HSCT and allo-HSCT were 72.5%?50.0%respectively(P=0.027);3 years DFS were 70.0%?49.5%(P=0.043);5 years OS were 71.0%?49.0%(P=0.024);5 years DFS were 69.5%?48.0%(P=0.033)respectively.The differences all had statistically significant.4?Prognosis factors:Results showed that gender and age had no effect on the long term survival(P-value were 0.397?0.637);the number of the infused CD34+ cells had effect on the 3 years OS of allo-HSCT patients(P=0.015);while it did not affect auto-HSCT 3 years OS(P=0.679).The rate of transplantation related complications(infection and bleeding)had significant difference on 3 years OS of auto-HSCT and allo-HSCT(P-value were 0.015?0.000).For allo-HSCT,the GVHD had no effect on 3 years OS(P=0.101).Conclusion:1.HSCT is a better choice for the treatment of some hematologic diseases.2.As compared with auto-HSCT,the transplantation related complications of allo-HSCT is high,while the recurrence rate is low.3.Gender and age have no effect on the long term survival,while the number of the infused CD34+ cells and transplantation related complications(infection and bleeding)may affect the longtime survival of HSCT patients. |
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