造血干细胞移植治疗急性髓系白血病40例临床观察  

Clinical observation on hematopoietic stem cell transplantation for treating 40 cases of acute myeloid leukemia

作　　者：叶珂[1] 廖明燕[2] 唐晓琼[2] 王利[2] 张红宾[2] 肖青[2] 刘林[1] 

机构地区：[1]重庆医科大学,重庆400016 [2]重庆医科大学附属第一医院血液科,重庆400042

出　　处：《现代医药卫生》2016年第7期986-989,992,共5页Journal of Modern Medicine & Health

摘　　要：目的评估造血干细胞移植（HSCT）治疗急性髓系白血病（AML）的疗效及相关并发症。方法选择2011~2014年在重庆医科大学附属第一医院血液科接受HSCT治疗的AML患者40例,分析AML患者HSCT后造血重建、疗效随访情况及总体生存率。结果 40例患者中,38例植入成功。在接受自体造血干细胞移植（auto-HSCT）和异基因造血干细胞移植（allo-HSCT）患者中,粒系重建的中位时间分别为12、14 d,巨核系重建的中位时间分别为14、20 d;随访1~47个月,无病生存27例（67.5%）,移植后复发6例,其中auto-HSCT 2例,allo-HSCT 4例（难治性复发2例,非难治性2例）;单倍体造血干细胞移植（hi-HSCT）7例,其中成功植入6例。接受auto-HSCT的患者总体生存率（OS）为85.7%,无病生存率（DFS）为78.6%,接受allo-HSCH的患者OS为65.4%,DFS为61.5%,两组患者OS比较,差异无统计学意义（P=0.183）。结论 auto-HSCT可作为AML患者完全缓解后无供者时的巩固治疗;allo-HSCT复发率低,大部分患者可获得临床治愈,而对于无全相合供者的AML患者,hi-HSCT也是相对安全且有效的选择。Objective To investigate the clinical efficacy and related complications of hematopoietic stem cell transplantation（HSCT） for treating acute myeloid leukemia（AML）. Methods Forty patients with AML receiving HSCT in our hospital during2011-2014 were selected and performed the analysis in the aspects of hematopoietic reconstruction,curative effect follow up and total survival rate. Results Among 40 cases of AML,38 cases were succeeded in HSCT,In the cases of auto-HSCT and allo-HSCT,the median time of neutrophils series reconstruction was 12 d and 14 d respectively,the macronucleus series reconstruction was14 d and 20 s respectively;during follow up for 1-47 months,27cases（67.5%） were non-disease survival,6 cases were recurred,including 2 cases of auto-HSCT and 4 cases of allo-HSCT [refractory recurrence in 2 cases and-HSCT and non-refractory recurrence in 2 cases;in 7 cases of hi-HSCT,6 cases were succeeded. The overall survival（OS） of cases receiving auto-HSCT was 85.7% and the disease free survival（DFS） rate was78.6%,OS of the cases receiving allo-HSCT was 65.4% and their DFC was 61.5%,OS had no statistical difference between the two groups（P=0.183）. Conclusion Auto-HSCT can serve as the consolidation therapy without donor after complete remission HSCT in the AML patients,allo-HSCT has low recurrence rate,most of patients can obtain clinical cure,but hi-HSCT also is relatively safe and effective selection for the AML patients without consistent donor.

关 键 词：白血病 髓样 急性 移植物抗宿主病 造血干细胞移植 存活率 单倍性 

分 类 号：R457.7[医药卫生—治疗学]