非血缘脐血移植治疗高危难治AML1-ETO阳性急性髓细胞白血病的疗效分析  

Efficacy Analysis of Unrelated Cord Blood Transplantation for High-Risk Refractory AML1-ETO Positive Myeloid Leukemia

作　　者：任佳荣 朱小玉 汤宝林 皖湘 童娟 张磊[1] 张旭涵 宋闿迪 姚雯 孙光宇 刘会兰 孙自敏 REN Jia-Rong;ZHU Xiao-Yu;TANG Bao-Lin;WAN Xiang;TONG Juan;ZHANG Lei;ZHANG Xu-Han;SONG Kai-Di;YAO Wen;SUN Guang-Yu;LIU Hui-Lan;SUN Zi-Min(Department of Hematology,Anhui Provincial Hospital,Anhui Medical University,Hefei 230001,Anhui province,China)

机构地区：[1]安徽医科大学附属省立医院血液科

出　　处：《中国实验血液学杂志》2019年第4期1246-1252,共7页Journal of Experimental Hematology

基　　金：安徽省科技攻关面上项目(1704a0802149)

摘　　要：目的:分析非血缘脐血移植(UCBT)治疗AML1-ETO^+急性髓系白血病(AML)患者中的植入、移植物抗宿主病(GVHD)及生存等临床结果。方法:2010年7月-2018年4月,单中心进行单份UCBT治疗高危难治性AML1-ETO+AML患者45例。对所有患者均采用清髓性预处理方案,应用环孢素A(CSA)联合吗替麦考酚酯(MMF)预防GVHD。结果:输注脐血总有核细胞(TNC)中位值为5.21(1.96-12.68)×10^7/kg受者体重,CD34+细胞数为5.61(0.56-15.4)×105/kg受者体重。42d中性粒细胞及120d血小板植入率分别为95.6%及86.7%,中性粒细胞绝对计数(ANC)>0.5×10^9/L和血小板≥20×10^9/L的中位时间分别为移植后16(12-18)d和37(17-140)d。移植后100dⅠ-Ⅳ度急性GVHD(aGVHD)的累积发生率为48.9%(95%CI33.5%-62.6%),Ⅱ-Ⅳ度aGVHD12例(33.3%)(95%CI20%-47.2%),Ⅲ-Ⅳ度aGVHD8例(20%)(95%CI9.8%-32.8%)。40例患者中5例于移植后100d出现慢性GVHD(cGVHD),其中4例为局限性,1例为广泛性。3例复发,2年累积复发率为9.5%(95%CI2.4%-22.8%)。中位随访时间23.5(0.9-89.67)个月,死亡10例,2年无病生存率(DFS)及总生存率(OS)分别72.7%和75.5%,多因素分析结果显示Ⅲ-Ⅳ度急性GVHD影响总生存。结论:UCBT是高危难治性AML1-ETO+AML的一种有效解救治疗措施。Objective:To analyze the clinical outcomes of engraftment,graft-versus-host disease (GVHD) and survival in the patients with AML1-ETO positive acute myeloid leukemia (AML) treated with unrelated umbilical cord blood transplantation (UCBT). Methods:Forty-Five patients with high-risk refractory AML1-ETO positive AML were treated with a single UCBT in a single center from July 2010 to April 2018. All the patients underwent a myeloablative preconditioning regimen,and cyclosporine A (CSA) combined with mycophenolate mofetil (MMF) was used to prevent GVHD. Results:The median value of total nucleated cells (TNC) in cord blood was 5.21 (1.96-12.68)×10^7/kg recipient body weight,and that of CD34^+ cells was 5.61 (0.56-15.4)×10^5/kg recipient weight. The implantation rate of neutrophil at 42 d and that of platelet at 120 d were 95.6% and 86.7%,respectively. The median time of absolute neutrophil count (ANC)> 0.5×10^9/L and platelet 20×10^9/L were 16 (12-18) d and 37 (17-140) d after transplantation,respectively. The cumulative incidence of Ⅰ-Ⅳ grade acute GVHD (aGVHD) at 100 d after transplantation was 48.9%(95% CI 33.5%- 62.6%),Ⅱ-Ⅳ grade aGVHD occurred in 12 cases (33.3%)(95% CI 20%-47.2%),and Ⅲ-Ⅳ grade a GVHD in 8 cases (20%)(95% CI 9.8%-32.8%). In 5 cases of 40 patients survived over 100 days,the chronic GVHD (cGVHD) occurred after transplantation,among which 4 were localized,and 1 was extensive. 3 patients relapsed,and the 2-year cumulative relapse rate was 9.5%(95% CI 2.4%-22.8%). The median follow-up time was 23.5 (0.9-89.67) months,10 patients died,2-year disease-free survival rate (DFS) was 72.7%,and overall survival rate (OS) was 75.5%. Multivariate analysis showed that Ⅲ-Ⅳ. acute GVHD (aGVHD) affected overall survival. Conclusion:UCBT is an effective rescue treatment for patients with high-risk refractory AML1-ETO positive AML.

关 键 词：非血缘脐血移植 急性髓细胞白血病 AML1-ETO阳性 

分 类 号：R457.7[医药卫生—治疗学]