非血缘脐血干细胞移植与同胞造血干细胞移植治疗MDS-EB和AML-MRC的对比观察  

Comparison of umbilical cord blood transplantation and hematopoietic stem cell transplantation from HLA-matched sibling donors in the treatment of myelodysplastic syndrome-EB or acute myeloid leukemia with myelodysplasia-related changes

作　　者：朱江 汤宝林[1] 宋闿迪[1] 张旭晗[1] 朱小玉 姚雯[1] 皖湘[1] 刘会兰[1] 孙自敏[1] Zhu Jiang;Tang Baolin;Song Kaidi;Zhang Xuhan;Zhu Xiaoyu;Yao Wen;Wan Xiang;Liu Huilan;Sun Zimin(Department of Hematology,Anhui Provincial Hospital,Anhui Medical University,Hefei 230001,China)

机构地区：[1]安徽医科大学安徽省立医院血液科,合肥230001

出　　处：《中华血液学杂志》2019年第4期294-300,共7页Chinese Journal of Hematology

基　　金：国际自然科学基金(9401067201).

摘　　要：目的比较非血缘脐血干细胞移植(UCBT)与同胞HLA全相合供者造血干细胞移植(MSD-HSCT)治疗骨髓增生异常综合征伴原始细胞增多(MDS-EB)和急性髓系白血病伴骨髓增生异常相关改变(AML-MRC)的临床疗效。方法回顾性分析2011年2月至2017年12月接受UCBT/MSD-HSCT的MDS-EB/AML-MRC患者64例,其中MDS-EB 38例,AML-MRC 26例。结果①与MSD-HSCT组比较,UCBT组AML-MRC患者比例较高[52.8%(19/36)对25.0%(7/28),P=0.025],中位年龄较低[13(1.5~52)岁对32(10~57)岁,P=0.001]。②UCBT组与MSD-HSCT组+42 d粒细胞植入率均为100%,中位植入时间分别为17.5(11~31)d、11.5(10~20)d;UCBT组+100 d血小板植入率为91.4%,中位植入时间为40(15~96)d,MSD-HSCT组+100 d血小板植入率为100.0%,中位植入时间为15(11~43)d。③UCBT组和MSD-HSCT组比较,+100 dⅡ~Ⅳ度、Ⅲ/Ⅳ度急性GVHD累积发生率、180 d移植相关死亡率、3年累积复发率、3年总生存率和3年无病生存率差异均无统计学意义(P>0.05)。④UCBT组3年慢性GVHD、重度慢性GVHD的累积发生率均低于MSD-HSCT组[28.3%(95% CI 13.4%~45.3%)对67.9%(95%CI 46.1%~82.4%),P=0.002;10.3%(95%CI 2.5%~24.8%)对50.0%(95%CI 30.0%~67.1%),P<0.001];UCBT组3年无严重急慢性GVHD及无复发生存(GRFS)率明显高于MSD-HSCT组[55.0%(95%CI 36.0%~70.6%)对28.6%(95%CI 13.5%~45.6%),P=0.038]。结论UCBT治疗MDS-EB/AML-MRC患者可获得比MSD-HSCT更好的移植后生存质量。Objective To compare the clinical efficacy of umbilical cord blood transplantation (UCBT) and hematopoietic stem cell transplantation from HLA-matched sibling donors (MSD-HSCT) in the treatment of myelodysplastic syndrome-EB (MDS-EB) or acute myeloid leukemia with myelodysplasia-related changes (AML-MRC). Methods A cohort of 64 patients (including 38 cases of MDS-EB and 26 cases of AML-MRC) who received UCBT/MSD-HSCT from February 2011 to December 2017 were retrospectively analyzed. Results ①Compared with MSD-HSCT group, UCBT group had a higher proportion of AML-MRC patients [52.8%(19/36) vs 25.0%(7/28), P=0.025], and a lower median age [13 (1.5-52) years vs 32 (10-57) years, P=0.001].②The engraftment of neutrophils both in UCBT and MSD-HSCT groups on +42 d was 100%, and the median engraftment time was 17.5 (11-31) d and 11.5 (10-20) d, respectively. The engraftment of platelet at +100 d in UCBT group was 91.4%, the median engraftment time was 40 (15-96) d;The engraftment of platelet at +100 d in MSD-HSCT group was 100%, and the median engraftment time was 15 (11-43) d.③There were no statistically significant differences in terms of the cumulative incidence of Ⅱ-Ⅳ and Ⅲ/Ⅳ aGVHD of 100 d and transplant related mortality (TRM) of 180 d, relapse rate, overall survival (OS), disease-free survival (DFS) between UCBT and MSD-HSCT groups (P>0.05).④The 3-year cumulative incidence of chronic GVHD (cGVHD) and severe chronic GVHD in UCBT group were lower than of MSD-HSCT group [28.3%(95%CI 13.4%-45.3%) vs 67.9%(95%CI 46.1%-82.4%), P=0.002;10.3%(95%CI 2.5%-24.8%) vs 50.0%(95%CI 30.0%-67.1%), respectively, P<0.001]. The cumulative 3-year incidence of GVHD-free and relapse-free survival (GRFS) of UCBT group was significantly higher than of MSD-HSCT group [55.0%(95%CI 36.0%-70.6%) vs 28.6%(95%CI 13.5%-45.6%), P=0.038]. Conclusion UCBT could obtain better quality of life after transplantation than MSD-HSCT in treatment of MDS-EB/AML-MRC.

关 键 词：脐血干细胞移植 造血干细胞移植 骨髓增生异常综合征 白血病 髓样 急性 存活率分析 

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