非血缘脐血移植挽救治疗难治复发成人急性白血病的疗效分析  

Efficacy analysis of unrelated cord blood transplantation in the treatment of refractory and relapsed adult acute leukemia

作　　者：褚先登 陈二玲[1] 来小玉 汤宝林[1] 郑昌成[1] 宋闿迪[1] 张旭晗[1] 童娟[1] 皖湘[1] 张磊[1] 刘会兰[1] 孙自敏[1] 

机构地区：[1]安徽省立医院、安徽医科大学附属省立医院血液科,合肥230001

出　　处：《中华血液学杂志》2018年第2期105-109,共5页Chinese Journal of Hematology

基　　金：国家自然科学基金（81470350）

摘　　要：【摘要】目的探讨非血缘脐血移植（ucBT）挽救治疗难治复发急性白血病（AL）患者的临床疗效和安全性。方法回顾性分析2009年11月至2017年5月22例行UCBT挽救治疗的难治复发成人AL患者的临床资料，全部患者采用清髓性预处理方案，均采用环孢素A／短程霉酚酸酯方案预防GVHD。结果①22例患者中男9例，女13例，中位年龄23（15～44）岁；中位体重52．5（43～82）kg。所有患者回输脐血有核细胞中位数为3．07（1．71—5．30）×107／kg（受者体重），CD34＋细胞中位数为1．60（0．63～3．04）×105／kg（受者体重）。②移植后42d髓系累积植入率为95．5％（95％C145．2％～99．7％），中位植入时间为19（13～27）d；移植后120d血小板累积植入率为81．8％（95％CI54．2％-93．6％），中位植入时间为42（20～164）d。③Ⅱ～Ⅳ度、Ⅲ～Ⅳ度急性GVHD发生率以及慢性GVHD2年累积发生率分别为36．4％、13．6％和40．3％。④移植后180d移植相关死亡率为22．7％；2年累积复发率为18．7％（95％CI3．6％～42．5％），2年累积无病生存率及累积总生存率分别为53．7％和58．1％。结论对于常规化疗无效的难治复发成人AL患者，初步结果显示采用UCBT安全、有效。Objective To explore the clinical efficacy and safety of unrelated umbilical cord blood transplantation （UCBT） in the treatment of refractory and relapsed acute leukemia （AL） patients. Methods The clinical data of 22 refractory and relapsed AL patients who were treated with UCBT as salvage therapy from November 2009 to May 2017 were retrospectively analyzed. All patients received a myeloablative conditioning regimen for prevention of graft-versus-host disease （GVHD） with cyclosporine A （CSA）/short course of mycophenolate mofetil （MMF）. Results （1）Of 22 patients, 9 cases were male and 13 female. The median age was 23 （15- 44） years and median weight of 52.5 （43- 82） kg. All patients were transplanted with a median umbilical cord blood nucleated cells of 3.07 （1.71-5.30）× 107/kg （by weight）, the median CD34＋ cells was 1.60 （0.63-3.04）× 105/kg （by weight）. （2）The myeloid cumulative implantation rate was 95.5% （95%CI 45.2-99.7%） after transplantation of 42 d, with the median implantation time of 19 （13-27） d. The platelet cumulative implantation rate after transplantation of 120 d was 81.8% （95%CI 54.2- 93.6%）, the median implantation time of 42 （20-164） d. （3）The incidence of Ⅱ-Ⅳ,Ⅲ-Ⅳ aGVHD and the 2 year cumulative incidence of cGVHD were 36.4%, 13.6% and 40.3% respectively. @ The transplant related mortality （TRM） after transplantation of 180d was 22.7%, 2 year cumulative rate of re/apse was 18.7% （95% CI 3.6-42.5%）, 2 year disease-free survival rate （DFS） and overall survival rate （OS） were 53.7% and 58.1%, respectively. Conclusion The preliminary results show that the use of UCBT is safe and effective for refractory and relapsed AL patients who fail to respond to conventional chemotherapy.

关 键 词：造血干细胞移植 白血病 急性 抗药性 肿瘤 复发 生存 

分 类 号：R733.71[医药卫生—肿瘤]