Analysis Of Recurrence After Allogeneic Hematopoietic Stem Cell Transplantation In Patients With Hematological Malignancies:A Single-Center Study

Objective: To analyze the survival,prognostic factors,prevention and treatment of recurrence after allogeneic hematopoietic stem cell transplantation(allo-HSCT)in patients with hematological malignancies,and to explore the relationship between immune reconstruction,loss of human leukocyte antigen(HLA-loss)and recurrence after transplantation.Methods: From July 2012 to June 2020,47 patients with relapse of hematological malignancies after allo-HSCT in the Hematology of second Hospital of Hebei Medical University were retrospectively analyzed.The average age was 31.79±12.82 years old,including 28 males,19 females,including 20 cases undergoing matched-sibling donor transplantation(MSD),26 cases undergoing haploidentical transplantation(HID)and 1 case undergoing matched-unrelated donor transplantation(MUD).Implantations of hematopoietic stem cells,incidence of graft versus host disease(GVHD)and incidence of post-recurrence overall survival(PROS)were analyzed statistically in matchded donor(MD)group and HID group.Multivariate analysis was used to analyze the risk factors related to PROS.Using spss 25.0statistical software,the measurement data obeyed the normal distribution using((?)±s),the t-test was used for comparison between groups,the skewness distribution using median(25%,75%),and the comparison between groups using Mann-Whitney U test.The multiple factors affecting PROS were analyzed by Cox proportional hazard regression model.The difference was statistically significant at the test level P<0.05.Results:1.The average implantation time of neutrophils in HID group and MD group was 12.04 ±2.03 d and 11.90 ±1.48 d,respectively(P=0.802)and the platelets implantation time in the two groups was 13.50 ±4.84 d and 12.33±1.74 d,respectively(P=0.298).There was no significant difference between the two groups.2.The cumulative incidence of grade Ⅱ-Ⅳ,Ⅲ/ a GVHD and cⅣGVHD were 40.4%,10.6% and 31.9%,respectively.The incidence of grade Ⅱ-Ⅳand grade Ⅲ/ Ⅳa GVHD in HID group and MD group were42.3%vs38.1%(P=0.579),11.5%vs9.5%,respectively(P=1.000).The incidence of c GVHD in the two groups was 34.6%,28.6%(P=0.659).The incidence of CMV,EBV and HC between the two groups were 53.8%vs42.9%(P=0.454)、19.2%vs19%(P=1.000)、42.3%vs19%(P=0.089).There was no significant difference in the incidence of CMV,EBV and HC between each group and the whole population.3.Patients with NK cell numbers day 30 > 190cells/ul experienced higher PROS(P=0.021).4.We found two patients with HLA-loss in 11 patients undergoing HID with DNA chimerism < 95%.Both patients were young women who were MRD positive before HID.No c GVHD occurred in both patients,and the 30 d absolute NK cell count was < 190cells/ul.5.The 1-year and 3-year PROS of patients receiving allo-HSCT were68.1% and 28.4%,respectively.The 1-year and 3-years PROS of patients receiving HID and MD were 78.9% vs 54.4% and 40.3% vs 14%,respectively(P= 0.048).6.Multivariate analysis showed that MD-HSCT、Ⅱ-Ⅳa GVHD and recurrence time<3 months were independent prognostic indictors for PROS.Conclusions:1.The PROS of MD group was shorter than that of the HID group in hematological malignancies.2.Patients with NK cell numbers day 30 >190cells/ul experienced higher PROS.3.There was no significant difference in the incidence of grade Ⅱ-Ⅳ and grade Ⅲ/ Ⅳa GVHD between HID group and MD group.4.MD-HSCT、Ⅱ-Ⅳa GVHD and recurrence time<3 months were the independent prognostic indictors for PROS.