难治复发性急性髓系白血病患者缓解状态对异基因造血干细胞移植预后影响的分析  

Impact of Disease Status on Outcomes of Allogeneic Hematopietic Stem Cell Transplantation in Patients with Refractory and Relapsed Acute Myeloid Leukemia

作　　者：周倩兰[1] 唐晓文[1] 孙爱宁[1] 仇惠英[1] 金正明[1] 苗瞄[1] 付铮铮[1] 赵丙瑞[1] 施晓兰[1] 陈广华[1] 吴德沛[1] 

机构地区：[1]苏州大学附属第一医院,江苏省血液研究所,卫生部血栓与止血重点实验室,江苏苏州215006

出　　处：《中国实验血液学杂志》2012年第4期954-958,共5页Journal of Experimental Hematology

基　　金：江苏省“科教兴卫”工程医学重点人才资助项目(编号RC2007072);江苏省人事厅“六大人才高峰”资助项目(编号07-B-019);江苏省卫生厅科技项目(编号H201125);江苏省政府留学基金资助

摘　　要：本研究探索难治复发性急性髓系白血病(AML)患者的缓解状态对异基因造血干细胞移植(allo-HSCT)预后的影响。对32例接受allo-HSCT的难治复发性AML的治疗结果进行回顾性分析,其中移植前未缓解(NR)17例,完全缓解(CR)15例,比较两组在治疗相关不良反应、白血病复发和无白血病生存率(LFS)等方面的差异。结果表明,两组病例在性别、年龄、细胞遗传学特征和移植方式等方面均具有可比性。除NR组中1例移植失败,1例死于重症肝静脉阻塞病以外,其余30例均获得造血重建。NR组与CR组aGVHD发生率分别为47.1%(8例)和33.3%(5例)。在可评估的患者中,NR组9例中5例发生cGVHD,CR组11例中4例发生cGVHD,两组发生aGVHD(P=0.335)和cGVHD(P=0.217)的差异均无统计学意义。NR组治疗相关死亡率(29.4%vs 14.3%,P=0.392)及移植后复发率(42.9%vs 26.7%,P=0.300)较CR组高,但差异均无统计学意义。中位随访13(1-124)个月,至今NR组和CR组各有6例无病生存,2年LFS两组相近(35.3%vs 40.0%,P=0.267)。对32例患者的单因素生存分析结果显示,年龄<35岁(P=0.044)及发生cGVHD(P=0.046)的患者总生存率(OS)显著延长。结论:单中心样本研究结果显示,allo-HSCT是挽救性治疗难治复发性AML的有效手段,移植前NR的患者预后与CR患者相比,allo-HSCT疗效及预后无显著性差异,提示对NR状态的难治复发性AML患者实施allo-HSCT,并通过移植后过继免疫治疗产生cGVHD,以期获得长期生存是可行的。The study was aimed to evaluate the impact of disease status on the outcomes of allogeneic hematopietic stem cell transplantation （allo-HSCT） in patients with refractory and relapsed acute myeloid leukemia （AML）. 32 patients with refractory and relapsed AML received allo-HSCT after myeloablative conditioning regimen, including 17 patients in no-remission（NR） and 15 patients in complete remission （CR）at the time of transplant. Treatment related adverse events, relapse rate and leukemia free survival（LFS） were analyzed. The results showed that the parameters of sex, age, cytogenetic risk and transplant procedures were comparable between the two groups. 30 patients had successful engraftment, except one had graft failure and one died from severe veno-occlusive disease in the NR group. The incidences of aGVHD in NR group and CR group were 47.1% （8 patients） and 33.5% （5 patients） respectively. Out of comparable patients, 5 from 9 patients in NR group developed with cGVHD, and 4 from 11 patients in CR group were subjected to cGVHD. There were no statistic difference in incidences of aGVHD and cGVHD between two group. Compa-red with CR group, NR group had a higher treatment-related mortality （29.4% vs 14.3%, P =0. 392） and relapse rate （42.9% vs 26.7% P =0.300）, but there was no significant difference. With a median follow-up of 13 （1 -124） months, 6 patients remained alive in both of the two groups , and the 2 year LFS of them were parallel （ 35.3 % vs 40.0%, P =0. 267 ）. Among these 32 patients, overall survival （OS） was better in patients with age 〈 35 years（ P = 0. 044）and with the appearance of cGVHD（ P = 0.046 ）. It is concluded that allo-HSCT is an effective salvage therapy for patients with refractory and relapsed AML, and the overall outcome seems unrelated to the disease status （ NR or CR） before transplantation, As such, for refractory and relapsed AML patients in non-remnission, performance of allo- HSCT to achieve long-term survival is feasible.

关 键 词：异基因造血干细胞移植 急性髓系白血病 预后 

分 类 号：R733.71[医药卫生—肿瘤] R457.7[医药卫生—临床医学]