难治性急性髓系白血病异基因造血干细胞移植治疗疗效分析  

Long term follow-up of patients with refractory acute myeloid leukemia undergoing allogeneic hematopoietic stem cell transplantation

作　　者：尹春荣 高雯慧 王紫薇 王苓[1] 唐暐[1] 王建民 胡炯[1] YIN Chunrong;GAO Wenhui;WANG Ziwei;WANG Ling;TANG Wei;WANG Jianmin;HU Jiong(Department of Hematology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Hematology,Changhai Hospital,Naval Medical University,Shanghai 200433,China)

机构地区：[1]上海交通大学医学院附属瑞金医院血液科,上海200025 [2]海军医科大学附属长海医院血液科,上海200433

出　　处：《内科理论与实践》2018年第2期76-80,共5页Journal of Internal Medicine Concepts & Practice

摘　　要：目的 :评价异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)治疗复发难治性急性髓系白血病(refractory acute myeloid leukemia,r AML)的疗效。方法:收集2000年1月至2015年6月在上海交通大学医学院附属瑞金医院和海军医科大学附属长海医院接受allo-HSCT治疗的r AML患者73例,按移植前疾病状态分为完全缓解(complete remission,CR)组(44例)和未缓解(non-remission,NR)组(29例),随访截止时间2015年12月31日,分析allo-HSCT后非复发死亡率(non-relapsing mortality,NRM)、粒细胞及血小板植入时间、移植物抗宿主病(graft versus host disease,GVHD)发生率、2年总生存(overall survival,OS)率、2年无病生存(disease-free survival,DFS)率等数据。结果 :所有患者移植后获得造血功能重建,中位随访时间470(230.5,1 011.5)d。所有患者2年OS率为56.5%,2年DFS率为41.8%。移植前CR组和NR组2年OS率分别为64.0%和45.6%(P=0.345),2年DFS率分别为45.6%和35.6%(P=0.393);移植前CR组和NR组NRM、粒细胞及血小板植入时间、GVHD发生率差异均无统计学意义。结论:allo-HSCT是治疗r AML的有效治疗手段,长期DFS为41.8%,移植前疾病状态是否达到CR对移植后的预后无显著影响。Objective To evaluate the long-term outcome of allogeneic hematopoietic stem cell transplantation（alloHSCT） in patients with refractory acute myeloid leukemia（r AML）. Methods A total of 73 cases with refractory AML underwent allo-HSCT at Shanghai Ruijin Hospital and Changhai Hospital between January 2000 to June 2015 were enrolled.Patients were classified into complete remission（CR）（44 cases） and non-remission（NR）（29 cases） groups according to the pre-transplant disease status. The follow-up was ended at end of December, 2015. The outcome of allo-HSCT evaluated included graft engraftment（time to granulocyte and platelet engraftment）, non-relapsing mortality（NRM）, incidence of acute and chronic graft versus host disease（GVHD）, 2-year overall survival（OS）, and 2-year disease-free survival（DFS） after alloHSCT. Results Hematopoietic engraftment was documented in all patients after transplantation. With a median follow-up of 470（230.5, 1 011.5） days, 2-year OS and DFS were 56.5% and 41.8%, respectively. According to pre-transplant disease status, 2-year OS in CR and NR groups were 64.0% and 45.6%, respectively（P=0.345）, while 2-year DFS were 45.6%and 35.6%, respectively（P=0.393）. There was no significant difference in engraftment, NRM and incidence of GVHD be-tween CR and NR groups. Conclusions Allo-HSCT is an effective therapeutic approach for r AML with a long term DFS rate around 41.8%. Whether the disease status reaching CR before transplantation has no significant effect on the progno-sis after transplantation.

关 键 词：异基因外周血造血干细胞移植 难治 急性髓系白血病 

分 类 号：R457.7[医药卫生—治疗学] R733.71[医药卫生—临床医学]