异基因造血干细胞移植后AML复发的危险因素分析及预测模型的构建

Analysis of Risk Factors for Relapse of AML after Allogeneic Hematopoietic Stem Cell Transplantation and Construction of Prediction Model

摘要: 目的：探讨急性髓系白血病(AML)患者接受异基因造血干细胞移植(allo-HSCT)后复发的影响因素，进而构建复发风险预测模型。方法：收集安徽医科大学第一附属医院行allo-HSCT的72例非M3型AML患者的临床资料，根据复发情况分为未复发组和复发组。通过单因素和多因素Logistic回归分析，筛选出影响移植后复发的独立危险因素，在此基础上构建并评价预测模型。结果：72例AML患者中，非复发组54例，复发组18例，多因素Logistic回归分析显示，染色体异常(P = 0.031)、移植前未缓解状态(P = 0.026)、移植后感染CMV (P = 0.032)是AML患者移植后复发的独立危险因素。构建预测模型的ROC曲线下面积为0.788 (95% CI: 0.673~0.902)，校准曲线斜率接近1，H-L拟合优度检验显示χ² = 0.446，P = 0.979，说明该模型区分度和校准度良好。结论：AML患者移植后复发的独立影响因素包括染色体异常、移植前未缓解状态及移植后感染CMV，据此构建的预测模型表现出较好的预测价值，可为临床识别高危复发患者提供重要参考。

Abstract: Objective: To investigate the factors influencing relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with acute myeloid leukemia (AML), and establish a model to predict relapse risk. Method: The study included 72 patients with non-M3 AML who received their first allo-HSCT at the First Affiliated Hospital of Anhui Medical University. Patients were divided into a non-relapse group and a relapse group based on their post-transplantation status. Univariate and multivariate Logistic regression analysis is used to screen out the independent risk factors affecting relapse after transplantation, and establish a prediction model based on this analysis and evaluate the performance of the model prediction models. Result: Among 72 AML patients, 54 cases were in the non-relapsed group and 18 cases were in the relapsed group. Multivariate Logistic analysis showed that chromosome abnormality (P = 0.031), non-remission status prior to transplantation (P = 0.026), and CMV infection after transplantation (P = 0.032) were independent relapse risk factors. The area under the ROC curve of the constructed prediction model was 0.788 (95% CI: 0.673~0.902), the slope of the calibration curve was close to 1, and the results of H-L goodness of fit test showed χ² = 0.446, P = 0.979, indicating that the model had good differentiation and calibration. Conclusion: The independent influencing factors of relapse after allo-HSCT in AML patients include chromosomal abnormality, non-remission state before transplantation, and CMV infection after transplantation. The prediction model constructed on this basis shows good predictive value, and can provide an important reference for identifying high-risk patients with relapse.