异基因造血干细胞移植治疗急性髓系白血病以及骨髓增生异常综合征  

Analysis of Allogeneic Hematopoietic Stem Cell Transplantation for Patients with Acute Myeloid Leukemia and Myelodysplastic Syndrome

作　　者：蔡大利[1] 高峰[1] 高然[1] 苏楠[1] 马凤宇 莫文斌[1] 李艳[1] 

机构地区：[1]中国医科大学附属第一医院血液科,沈阳110001

出　　处：《中国医科大学学报》2017年第1期45-49,共5页Journal of China Medical University

摘　　要：目的观察异基因造血干细胞移植治疗急性髓系白血病以及骨髓增生异常综合征的疗效和安全性。方法回顾性分析2011年4月至2016年4月在我院接受了异体造血干细胞移植的21例急性髓系白血病和8例骨髓增生异常综合征病例。其中,人类白细胞抗原(HLA)全相合异基因移植16例,单倍体相合异基因移植10例,同基因移植3例。预处理方案采用Bu Cy2±化疗,或全身照射(TBI)7.5~10 Gy联合环磷酰胺120 mg/kg±化疗。HLA全相合移植应用环孢素联合短程甲氨喋呤预防移植物抗宿主病(GVHD),单倍体相合移植采用兔抗人胸腺细胞球蛋白+环孢素+骁悉+甲氨喋呤+糖皮质激素,同基因移植无需GVHD预防。结果所有患者获得供者型造血重建。移植后100 d内死亡2例,随访中位时间23个月(1~60个月)。Ⅱ~Ⅳ度急性GVHD发生率为23.1%(6/26),其中Ⅲ/Ⅳ度2例;慢性GVHD 50%,其中轻度c GVHD 3例,中度6例,重度4例。移植相关死亡率13.8%(4/29),复发死亡率20.7%(6/29),2年总体生存率68.09%(95%CI:45.77%~82.78%),无病生存率60.22%(95%CI:38.19%~76.55%)。生存分析显示高危患者仍存在较高复发风险。结论 HLA全相合及单倍体相合异基因造血干细胞移植是安全、有效、可行的。严密监测高危患者,提前或及早干预是必要的,有利于进一步提高移植疗效。Objective To evaluate the efficacy and safety of HLA identical and haploidentical related allogeneic hematopoietic stem cell trans- plantation in the treatment of acute myeloid leukemia （AML） and myeledysplastic syndrome （ MDS ）. Methods A total of 21 patients with AML and 8 patients with MDS who underwent allogeneic hematopoietic stem cell transplantation in our hospital from April 2011 to April 2016 were ana- lyzed retrospectively, including 16 cases of HLA-identical allogeneic HSCT, 10 cases of haploidentical allogeneic HSCT, and 3 cases of syngeneic HSCT. BUCY2 or TBI plus CY _＋ chemotherapeutic agents was the regular conditioning regimen. No graft versus host disease （GVHD） prophylax- is was required for syngeneic HSCT, but cyclosporine in combination with methotraxate was essential for allogeneic HSCT, cyclosporine, methotrax- ate, antithymocyte globulin, mycophenolate mofetil and glucosteroids for haploidentieal HSCT. Results All patients achieved fully donor-originat- ed hematopoiesis. Two patients died of severe acute GVHD within 100 days post HSCT. Acute GVHD with grade Ⅱ-Ⅳ occurred in 23.1% （6/26） patients, chronic GVHD in 50% patients, therapy and relapse-relevant mortality was 4/29 （ 13.8% ） and 6/29 （20.7%） cases within a median follow- up of 23 （1-60） months, respectively. Two-year overall survival and leukemia free survival rates are 68.09% （ 95%CI： 45.77%-82.78% ） and 60.22 % （95%CI： 38.19%-76.55% ）, respectively. High risk AML is still the main challenge to long-term leukemia free survival. Conclusion HLA identical and haploidentical allogeneic HSCT for AML and MDS is safe, effective and feasible. Minimal residual disease monitoring and pre-ventative as well as preemptive intervention is necessary for improving prognosis of high risk AML.

关 键 词：造血干细胞移植 急性髓系白血病 骨髓增生异常综合征 移植物抗宿主病 

分 类 号：R557[医药卫生—血液循环系统疾病]