脐血移植治疗高危急性白血病的临床研究  

Clinical study of umbilical cord blood transplantation for patients with high risk acute leukemia

作　　者：何文多[1] 丁家华[1] 

机构地区：[1]东南大学附属中大医院血液科,南京210009

出　　处：《中华移植杂志（电子版）》2017年第4期225-230,共6页Chinese Journal of Transplantation(Electronic Edition)

摘　　要：目的探讨高危急性白血病患者接受非血缘脐血移植(UCBT)的临床疗效。方法回顾性分析东南大学附属中大医院血液科2014年3月至2016年4月经UCBT治疗的14例高危急性白血病患者的临床资料。移植前疾病状态:第1次完全缓解(CR1)6例,第2次完全缓解(CR2)4例,疾病进展期(初发未缓解或复发未缓解)4例。10例患者接受单份脐血移植,4例接受双份脐血移植。12例患者采用清髓性不含抗胸腺细胞球蛋白(ATG)预处理方案,2例HLA 4/6相合患者加用ATG。采用环孢素联合吗替麦考酚酯(MMF)预防移植物抗宿主病(GVHD)。采用Spearman秩相关分析输注CD34+细胞计数与血小板植入时间、急性GVHD发生率与脐血相合程度的关系以及影响OS的相关因素;应用Kaplan-Meier法评估患者移植2年累积及3年预期总生存率(OS)、无白血病生存率(LFS)及GVHD无复发生存率(GRFS)。结果随访至2017年10月,中位随访时间为27.5个月(1~42个月),随访期间4例患者死亡,2例死亡原因为复发,2例为感染。14例患者中,1例移植后40 d死于面部软组织感染,其余13例均于移植后30 d内获得中性粒细胞植入,植入中位时间为17 d(11~29 d)。12例于移植后60 d内获得血小板植入,血小板植入中位时间为33 d(25~59 d)。输注CD34+细胞计数同血小板植入时间相关(r=-0.62,P<0.05)。急性GVHD发生率与脐血相合程度相关(r=-0.55,P<0.05)。移植后100 d内11例患者尿CMV-DNA拷贝数升高,持续中位时间为22 d(6~50 d)。患者中有3例复发,其原发病均为急性淋巴细胞白血病;10例移植前达CR1和CR2患者中9例随访期间未复发。患者移植后6个月KPS评分中位数为95分(80~100分),环孢素、MMF、糖皮质激素停药中位时间分别为移植后113、35、116 d。以Kaplan-Meier法估算患者2年累积及3年预期OS、LFS及GRFS均为72%。移植相关死亡率为14.2%。影响OS的相关因素为:患者移植后中性粒细胞植入时间(r=-0.70,P<0.05),移植前疾�Objective To evaluate the clinical efficacy of umbilical cord blood transplantation（ UCBT） on patients with high-risk acute leukemia. Methods The clinical data of 14 patients with high-risk acute leukemia who got UCBT in the Department of Hematology of Zhongda Hospital Affiliated to Southeast University from March 2014 to April 2016 were retrospectively analyzed. Pretransplant disease status： 6 patients got first complete remission（ CR1） after chemotherapy,4 cases got second complete remission（ CR2） after chemotherapy,4 patients were in the state of disease progression（ nonremission after incipience or recurrence）. Ten patients received single cord blood transplantation and4 patients received double cord blood transplantation. 12 patients were pretreated with myeloablative and were not treated with anti-thymocyte globulin（ ATG）,and 2 HLA 4/6 matched patients received ATG. All the patients received both cyclosporin and mycophenolate mofetil（ MMF） to prevent acutegraft-versus-host disease（ GVHD）. The relationship between the number of transfused CD34＋cells and implantation time of platelet, and the relationship between incidence rate of GVHD and compatibility of cord blood were both analysed by Spearman rank correlation. Influencing factors of overall survival（ OS） were also analysed by Spearman rank correlation. Two-year accumulative and3-year probability of OS,leukemia-free-survival（ LFS）,GVHD-free/relapse-free survival（ GRFS）were evaluated by Kaplan-Meier method. Results The median follow-up time was 27. 5 months（ 1-42 months） up to October 2017. Four patients died during the follow-up period（ 2 patients died of relapse and 2 patients died of infection）. One case died of facial soft tissue infection 40 days after transplantation,and the other 13 cases got neutrophil implantation within 30 days after transplantation.The median time of neutrophil implantation was 17 days（ 11-29 d）. Platelets were implanted in12 cases within 60 days after transplantation,and t

关 键 词：非血缘脐血移植 高危急性白血病 复发 移植物抗宿主病 生活质量 

分 类 号：R733.71[医药卫生—肿瘤]