The Clinical Study Of Chronic Graft-versus-host Disease Following Haploidentical Transplantation Combined Infusion With A Third Party Cord Blood

ObjectiveTo investigate the incidence,risk factors and survival of c GVHD patients in combination of a haploidentical donor supported with an unrelated umbilical cord blood for hematopoietic stem cells transplantation(haplo-cord-HSCT).Method300 hematological malignancies individuals who received dual transplantation were enrolled in the study between January 2012 and July 2016 at the department of Hematology in the First Affiliated Hospital of Soochow University.The clinical diagnosis and scoring the severity of c GVHD syndromes according the National Institutes of Health(NIH)consensus conference in the 2014 update.Cox proportional hazards regression was used to identify risk factors associated with transplant outcomes.A nomogram was formulated based on the results of COX analysis and was evaluated by concordance index(C-index)and calibration plots.ResultDuring follow-up with a median time of 26.4 months(range 0.2–61.8)post transplantation,the 1-year,3-year and 5-year cumulative incidence of c GVHD was 26.3%(95% confidence interval [CI],23.5%~29.1%),30.3%(95% CI,27.3%~33.3%)and 32.2%(95% CI,28.7%~35.7%).In multivariate analysis,the c GVHD overall survival(GOS)were associated with primary diseases relapse,thrombocytopenia,bronchiolitis obliterans syndrome(BOS),and steroid-refractory c GVHD(SR-c GVHD),meanwhile,the count of infused CD34+ cells(≥3.46×106/kg)from haploidentical graft was a protective factor affecting GOS.In the present study,a nomogram for predicting GOS was initially proposed using these five variables,the concordance index(C-index)was 0.877(95% CI,0.859~0.895)for the accuracy evaluation of the nomogram.ConclusionOur data suggest that,the 5-year cumulative incidence of c GVHD was 32.2% after haplo-cord-HSCT with hematological malignancies.Relapse,thrombocytopenia,BOS and SR-c GVHD were independent risk factors for GOS,whereas CD34+≥3.46×106/kg was a protective factor affecting GOS.In addition,this prognostic model and nomogram may help clinicians selecting reasonable treatment strategies as soon as possible in practice.