allo-HSCT治疗进展期难治性急性髓系白血病的长期随访结果  

作　　者：周华[1] 周倩兰[1] 唐晓文[1] 葛玲[1] 孙爱宁[1] 吴德沛[1] 

机构地区：[1]苏州大学附属第一医院血液科,215006

出　　处：《浙江临床医学》2014年第7期1017-1018,1021,共3页Zhejiang Clinical Medical Journal

基　　金：国家自然科学基金面上项目（81270645）,江苏省自然科学基金面上项目（BK2012627）,江苏省高校自然科学研究项目（11KJB320015）,江苏省卫生厅科研项目（H201125）,江苏省临床医学中心（ZX201102）

摘　　要：目的：观察清髓性异基因造血干细胞移植（allo-HSCT）治疗进展期难治性急性髓系白血病（AML）的临床疗效。方法对31例未缓解期难治性AML患者，采用改良马利兰＋环磷酰胺（24例）或全身放疗＋环磷酰胺（7例）的清髓性预处理方案行allo-HSCT，采用环孢菌素A（CsA）加短程甲氨蝶呤（MTX）预防移植物抗宿主病（GVHD），部分患者加入霉酚酸酯（MMF）。结果27例患者成功获得造血重建，中性粒细胞〉1.0×10^9/L和血小板〉20×10^9/L的中位时间分别为12（10-14）d和13（10-16）d。急性GVHD发生率为42.3%（11/27），可评估的23例患者中8例发生慢性GVHD，均为局限性。移植相关病死率为22.6%（7例），移植后成功获得完全缓解的25例患者中8例血液学复发，其中3例合并髓外复发，复发率为32%。中位随访23（4-93）个月，至今有14例患者无病生存（DFS），2年DFS为45.4%。结论 allo-HSCT治疗进展期难治性AML仍不失为一种有效的挽救手段，其中发生慢性GVHD的患者预后较好，而移植相关并发症及移植后复发是影响患者生存的主要因素。Objective To evaluate the efficacy of myeloablative allogeneic hematopietic stem cell transplantation（allo-HSCT）for treatment of refractory acute myeloid leukemia（AML）not in remission. Methods The Results of 31 patients including myeloablative regimen 24 ones using busulfan/cyclophosphamideor and 7 ones receiving total-body irradiation/cyclophosphamide followed by allo-HSCT. Graft versus host disease（GVHD）prophylaxis was CsA plus short term MTX,mycophenolate mofetil （MMF）was also used in some of the patients. Results 27 patients engrafted successfulIy,the median times for their neutrophil〉1.0×10^9/L and platelet〉20×10^9/L were 12（10-14）days and 13（10-16）days after transplantation respectively. The incidence of aGVHD were 42.3%（11/27）. Among the 23 evaluable patients,8 experienced local chronic GVHD. The treatment related mortality was 22.6%（7/31）,Among the 25 patients who got complete remission after transplantation,8 patients suffered hematologic relapse,and 3 of them also had extramedullary relapse,the relapse rate was 32%.With a median follow-up of 23（4-81）months,14 patients remain alive until now,2 years’ DFS was 45.4%. Conclusion Allo-HSCT is still an effective salvage therapy for refractory AML not in remission. Patients with cGVHD had a better prognosis,transplant-related complications and recurrence are critical for the outcomes of allo-HSCT.

关 键 词：异基因造血干细胞移植 清髓性 急性髓细胞白血病 难治 

分 类 号：R733.71[医药卫生—肿瘤]