Objective: To determine the influence of donor-recipient sex matching on outcome of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) for acute leukemia in the setting of T-cell-replete transplants. Methods: The retrospective study is based on 1 160 consecutive patients who received their first haplo-HSCT for acute leukemia between April 2002 and December 2014 at Peking University Institute of Hematology. The patients were divided into the sex-matched group and sex-mismatched group in terms of the recipient and donor sex. Then we conducted an analysis in four subgroups, male patients with male donors (M→M), male patients with female donors (F→M), female patients with female donors (F→F), and female patients with male donors (M→F). Transplant outcomes were measured in terms of hematopoietic recovery, acute graft versus host disease (aGVHD), relapse, nonrelapse mortality (NRM), disease-free survival (DFS) and overall survival (OS) in the above four subgroups. Then univariate and multivariate analysis were conducted. Results: There was a higher 3-year and 5-year NRM but no difference in other transplant outcomes in sex-mismatched group when compared with the sex-matched group. F→M was compared with M→M, and the former group had higher 3-year and 5-year cumulative incidences of NRM (25.5% vs 16.1%, P=0.002; 27.1% vs 17.3%, P=0.002), decreased 5-year DFS (56.9% vs 64.4%, P=0.044), decreased 3-year OS (62.6% vs 69.8%, P=0.045). There was no significant difference in 3-year DFS and 5-year OS. There was no significant difference in grade Ⅱ-Ⅳ aGVHD and cGVHD incidence. When F→F group was compared with M→F group, only a higher grade Ⅱ-Ⅳ aGVHD incidence (43.9% vs 34.6%, P=0.047) existed. F→M was proved to be the independent risk factor influencing NRM and OS in multivariate analysis. Conclusion: In haplo-HSCT for acute leukemia, the donor-recipient sex combination of male patients with female donors was of a poorer prognosis, so a male donor was a better choice for a male patient.
目的： 观察供受者性别组合对单倍体相合造血干细胞移植（haplo-HSCT）治疗急性白血病预后的影响。 方法： 回顾性分析2002年4月至2014年12月在北京大学血液病研究所接受haplo-HSCT的1 160例急性白血病患者的临床资料，根据供受者性别组合分为供受者性别相合组、不合组，并进一步分为男供男、女供男、女供女、男供女4个亚组。比较各组移植后造血重建、移植物抗宿主病（GVHD）、复发、非复发死亡率（NRM）、无病生存（DFS）以及总生存（OS）情况，并行单因素及多因素分析。 结果： 供受者性别不合组3、5年累积NRM均高于性别相合组[21.7%（95%CI 20.4%~23.0%）对15.8%（95% CI 14.8%~16.8%），P=0.010；22.6%（95% CI 21.1%~24.1%）对16.8%（95% CI 15.8%~17.8%），P=0.013]，其他预后指标差异无统计学意义。女供男组与男供男组比较，3年及5年NRM较高[25.5%（95%CI 23.2%~27.8%）对16.1%（95%CI 14.9%~17.3%），P=0.002；27.1%（95%CI 24.7%~29.5%）对17.3%（95% CI 15.9%~18.7%），P=0.002]，5年DFS率、3年OS率较低[56.9%（95% CI 51.2%~63.0%）对64.4%（95%CI 60.0%~69.0%），P=0.044；62.6%（95%CI 57.1%~68.5%）对69.8% （95%CI 65.7%~74.2%），P=0.045]，3年DFS率及5年OS率差异无统计学意义（P>0.05），Ⅱ~Ⅳ度急性GVHD、慢性GVHD累积发生率差异无统计学意义（P>0.05）。女供女组与男供女组比较，Ⅱ~Ⅳ度急性GVHD累积发生率较高[43.9%（95%CI 40.5%~47.3%）对34.6%（95%CI 31.7%~37.5%），P=0.047]，慢性GVHD累积发生率、复发率、NRM、DFS率、OS率差异均无统计学意义（P>0.05）。多因素分析显示女供男性别组合是影响NRM、OS的独立危险因素。 结论： 女供男是haplo-HSCT治疗急性白血病预后较差的性别组合，男性患者应优先选择男性供者。.
Keywords: Donor selection; Haploidentical hematopoietic stem cell transplantation; Leukemia, acute; Prognosis.