ДИНАМИКА ХИМЕРИЗМА КАК ФАКТОР ПРОГНОЗА РАЗВИТИЯ РЕЦИДИВОВ ПОСЛЕ АЛЛОГЕННОЙ ТРАНСПЛАНТАЦИИ ГЕМОПОЭТИЧЕСКИХ СТВОЛОВЫХ КЛЕТОК ПРИ ОНКОГЕМАТОЛОГИЧЕСКИХ ЗАБОЛЕВАНИЯХ

Рецидив основного заболевания остается одной из главных проблем и наиболее частых причин смертности после аллогенной трансплантации гемопоэтических стволовых клеток (аллоТГСК) у пациентов с онкогематологическими заболеваниями (ОГЗ). Мониторинг химеризма позволяет оценить приживление трансплантата и предсказать развитие рецидивов. Изучены результаты 104 аллоТГСК, которые были проведены с 2009 по 2016 г. у пациентов с ОГЗ. Установлено, что увеличивающийся смешанный химеризм (СХ) является неблагоприятным фактором прогноза для бес- событийной выживаемости (HR = 6,9, p < 0,0001) и ассоциирован с высоким риском развития рецидивов (HR = 12,2, p < 0,0001) после аллоТГСК. Бессобытийная выживаемость в группе с полным донорским (ПДХ), уменьшающимся СХ и увеличивающимся СХ составила 68,1 ± 6,4; 60,0 ± 21,9 и 0 % (p < 0,0001), кумулятивная частота развития рецидивов – 10,8 ± 4,6; 0 и 81,3 ± 10,8 % (p < 0,0001) соответственно. Увеличение клеток реципиента выявлялось за 2–435 (медиана 23,5) сут до гематологического рецидива в 10 (62,5%) из 16 случаев. Увеличивавшийся СХ раньше и чаще выявлялся в костном мозге, чем в периферической крови (p = 0,06). В разгар гематологического рецидива химеризм в периферической крови может быть полностью донорским. У пациентов с полным донорским химеризмом развитие острой реакции «трансплантат против хозяина» наблюдалось чаще, чем у пациентов с СХ (p = 0,0004). 

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