Abstract: Objective To explore the incidence and risk factors of graft-versus-host disease(GVHD)secondary to allogeneic hematopoietic stem cell transplantation(allo-HSCT)in patients with acute lymphoblastic leukemia(ALL). Methods The clinical data of 57 ALL patients who received allo-HSCT in our hospital during Oct. 2010 and Oct. 2018 山 东 大 学 学 报 (医 学 版)57卷7期 -孙菲菲,等.57例急性淋巴细胞白血病异基因造血干细胞移植后抗宿主病的发生及影响因素分析 \=- were retrospectively analyzed. The information primary diseases, HSCT, overall survival(OS), leukemia-free survival(LFS), relapse rate(RR)and non-relapse mortality(NRM)was collected. The incidence, severity and risk factors of GVHD were analyzed. Results The donors were human leukocyte antigen(HLA)-allele mismatched for 37 cases, and matched for 20 cases(2 of which were unrelated). The donors for 24 cases had the identical blood type as the recipients, while donors for 37 cases had incompatible blood type. The donors for 30 cases were the same gender as the recipients, while donors for 27 cases were different gender. Median day of neutrophil and platelet engraftment was 12 d(range: 6-20 d)and 13 d(range: 9-47 d), respectively. Accumulative incidence of acute GVHD(aGVHD)was 53.4%(grade Ⅰ-Ⅱ: 42.8%; grade Ⅲ-Ⅳ: 10.8%). The cumulative incidence of chronic GVHD(cGVHD)was 20.3%, of which 5.3% was extensive and 15.1% was limited. Survival analysis showed that the 3-year OS and LFS of patients with grade Ⅲ-Ⅳ aGVHD were significantly lower than those without or with grade Ⅰ-Ⅱ aGVHD(20% vs 69.8%, 66.7%, χ2=17.243, P<0.001; 20% vs 60.8%, 71%, χ2=9.463, P=0.009), with RR and NRM increased(60% vs 33.7%, 23.9%, χ2=1.788, P=0.409; 50% vs 0.71%, 0.59%, χ2=21.344, P<0.001). The 3-year OS and LFS of patients with cGVHD were lower than those without cGVHD by no significant difference(44.4% vs 67.6%, χ2=0.142, P=0.706; 50% vs 62.4%, χ2=0.236, P=0.627). Multivariate analysis showed that HLA mismatch was a significantly independent risk factor for aGVHD. Gender difference between donors and recipients was an marginally significant independent factor of cGVHD. Conclusion GVHD is an important complication of allo-HSCT in ALL patients. Patients with grade Ⅲ-Ⅳ aGVHD have poor prognosis. HLA mismatch is an independent risk factor for aGVHD.

Key words: Acute lymphoblastic leukemia, Allogeneic hematopoietic stem cell transplantation, Graft-versus-host disease, Gender of donors and recipients, Human leukocyte antigen