移植前微小残留病对高危急性淋巴细胞白血病单倍体HSCT疗效的影响  

Influence of minimal residual disease before transplantation on outcome of haploidentical hematopoietic stem cell transplantation for high-risk acute lymphoblastic leukemia

作　　者：谭业辉[1] 刘晓亮[1] 刘宇[1] 杜雅哲 张明[1] 张云蔚[1] 李佳[1] 苏龙[1] 刘蒙蒙[1] 高素君[1] Tan Yehui;Liu Xiaoliang;Liu Yu;Du Yazhe;Zhang Ming;Zhang Yunwei;Li Jia;Su Long;Liu Mengmeng;Gao Sujun(Department of Hematology,the First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院血液科,长春130021

出　　处：《中华器官移植杂志》2018年第6期344-349,共6页Chinese Journal of Organ Transplantation

基　　金：吉林省发改委课题(2016C051-1);吉林省科技厅课题(20150204080SF).

摘　　要：目的分析血缘单倍体造血干细胞移植(HID-HSCT)治疗高危急性淋巴细胞白血病(ALL)的疗效,并探讨移植前微小残留病(MRD)对预后的影响。方法对2013年1月至2018年1月行HID-HSCT的39例高危ALL进行回顾分析,比较移植前MRD阳性及MRD阴性患者的临床特征、干细胞植活、并发症、存活和复发情况。结果39例患者均顺利植活,3年整体存活率(OS)为54.67%,无疾病存活率(DFS)为40.96%,急性移植物抗宿主病(aGVHD)发生率为53.8%,其中Ⅱ~Ⅳ度aGVHD发生率为23.1%,Ⅲ~Ⅳ度aGVHD发生率为2.6%。MRD阳性与MRD阴性患者之间细胞植活、GVHD发生、巨细胞病毒(CMV)血症及出血性膀胱炎等并发症的差异均无统计学意义。MRD阳性患者DFS与OS较MRD阴性患者显著减低,累积复发率明显升高,累积治疗相关死亡率的差异无统计学意义。结论HID-HSCT是治疗高危ALL的有效手段,但移植前MRD阳性患者复发率高,预后差。移植前应考虑调整策略以降低体内肿瘤残留,优化移植体系,以提高移植后存活率。Objective To analyze the effect of haploidentical hematopoietic stem cell transplantation (HID-HSCT) on high-risk acute lymphoblastic leukemia (ALL),and to explore the influence of minimal residual disease (MRD) before transplant on the outcomes.Methods A retrospective analysis was performed on 39 high risk ALL patients receiving HID-HSCT in our hospital from Jan.2013 to Jan.2018.The clinical features,stem cell engraftment,complications,survival and recurrence were compared between patients with pretransplant MRD+ and MRD-.Results All the 39 patients presented with successful engraftment.The overall survival (OS) was 54.67%;the disease free survival (DFS) was 40.96%;the incidence rate of acute graft versus host disease (aGVHD) was 53.8%,including 23.1% Ⅱ-Ⅳ degree aGVHD and 2.6% Ⅲ-Ⅳ degree aGVHD.There was no significant difference in stem cell engraftment,GVHD,cytomegalovirus infection and hemorrhagic cystitis between MRD+ and MRD- patients.DFS and OS in MRD+ patients were significantly lower than those in MRD- patients;the cumulative RR rate increased significantly,and there was no significant difference in cumulative TRM.Conclusion HID-HSCT was an effective method to treat high-risk ALL,but MRD+ patients had high recurrence rate and poor prognosis.Strategy adjustment should be considered to reduce tumor residual and the transplantation strategy should be optimized for these kinds of high risk patients,so as to improve long-term outcomes.

关 键 词：急性淋巴细胞白血病 高危 造血干细胞移植 微小残留病 

分 类 号：R733.71[医药卫生—肿瘤]