疾病危险度-共患病指数在单倍型造血干细胞移植中的应用

• Published in: 工程（英文） Vol. 7; no. 2; pp. 162 - 中插42
• Main Authors: 莫晓冬, 张晓辉, 许兰平, 王昱, 闫晨华, 陈欢, 陈育红, 韩伟, 王峰蓉, 王景枝, 刘开彦, 黄晓军
• Format: Journal Article
• Language: Chinese
• Published: Peking University People's Hospital,Peking University Institute of Hematology,National Clinical Research Center for Hematologic Disease,Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,100044,China 2021; Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies,Chinese Academy of Medical Sciences (2019RU029),Beijing 100073,China; Peking-Tsinghua Center for Life Sciences,Academy for Advanced Interdisciplinary Studies,Peking University,Beijing 100871,China; Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies,Chinese Academy of Medical Sciences (2019RU029),Beijing 100073,China%Peking University People's Hospital,Peking University Institute of Hematology,National Clinical Research Center for Hematologic Disease,Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,100044,China%Peking University People's Hospital,Peking University Institute of Hematology,National Clinical Research Center for Hematologic Disease,Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,100044,China
• Subjects: 疾病风险共病指数; 造血细胞移植; Hematopoietic cell transplantation; 共病指数; Disease risk index; comorbidity index; 单倍体; Disease risk comorbidity index; Haploidentical; 疾病风险指数; 造血干细胞移植; Hematopoietic stem cell transplantation
• ISSN: 2095-8099

本文的研究目的是基于疾病危险度指数(disease risk index, DRI)和造血干细胞移植共患病指数(hematopoietic cell transplantation-specific comorbidity index, HCT-CI),提出适合单倍型造血干细胞移植(haploidentical hematopoietic stem cell transplantation, haplo-HSCT)患者的疾病危险度-共患病指数(disease risk comorbidity index, DRCI).文中通过一个训练队列(n = 593)确定了无疾病生存(disease-free survival, DFS)的预测因素,然后对这些因素进行赋值,从而建立DRCI,并通过验证队列(n = 296)检验积分系统的有效性.多因素分析确定了DFS的两个独立影响因素:移植前DRI以及HCT-CI.我们为极高危DRI赋值2分,为高危DRI和中、高危HCT-CI各赋值1分,从而形成适合haplo-HSCT的DRCI(即haplo-DRCI).在验证队列中,低危、中危、高危组患者移植后3年的累积DFS率分别为65.2% (95% CI, 58.2%～72.2%)、55.8% (95% CI, 44.9%～66.7%)和32.0% (95% CI, 5.8%～58.2%) (P = 0.005).Haplo-DRCI 还可以预测不同疾病亚组,尤其是急性白血病患者移植后的DFS.此外,在独立的历史队列中(n = 526),较高的haplo-DRCI积分同样与较高的复发率、较高的非复发死亡率(non-relapse mortality, NRM)、较差的DFS率和较差的总体生存率(overall survi- val, OS)相关.这些结果表明,haplo-DRCI积分可以有效地对接受haplo-HSCT的患者进行危险分层,更好地预测哪些患者更能获益于haplo-HSCT.