经粒细胞集落刺激因子动员的亚标准剂量供者干细胞输注治疗异基因造血干细胞移植后复发急性白血病患者的临床分析  

Clinical analysis of sub-standard dose of donor stem cell infusion mobilized by granulocyte colony-stimulating factor in treatment of relapsed acute leukemia after allogenic hematopoietic stem cell transplantation

作　　者：王晓宁[1] 张莹 任娟[1] 朱化超 习杰英[1] 张梅[1] 贺鹏程[1] Wang Xiaoning;Zhang Ying;Ren Juan;Zhu Huachao;Xi Jieying;Zhang Mei;He Pengcheng(Department of Hematology,First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,Shaanxi Province,China)

机构地区：[1]西安交通大学第一附属医院血液内科,710061

出　　处：《国际输血及血液学杂志》2019年第6期476-481,共6页International Journal of Blood Transfusion and Hematology

基　　金：陕西省自然科学基金(2019-JM-564)。

摘　　要：目的 探讨经粒细胞集落刺激因子(G-CSF)动员的亚标准剂量供者干细胞输注(DSI)治疗异基因造血干细胞移植(allo-HSCT)后复发急性白血病(AL)患者的临床疗效和预后.方法 选择2010年1月至2017年4月,于西安交通大学第一附属医院血液内科行allo-HSCT后复发的17例AL患者为研究对象.按照复发后治疗方案的不同,将研究对象分为DSI联合化疗组(n=7)和单纯化疗组(n=10).采用回顾性分析方法,收集2组allo-HSCT后复发AL患者的基本临床资料.观察2组患者的DSI输注剂量、治疗结果、不良反应及生存结局.采用Kaplan-meier法绘制2组患者总体生存(OS)及首次复发后的生存期(SAR)曲线.OS率及SAR率的组间比较采用Log-rank检验.本研究经西安交通大学第一附属医院伦理委员会批准(批号:XJTU1AF2010LSL-020),所有患者接受治疗前均已签署知情同意书.结果 ①DSI联合化疗组患者中位年龄为28岁(11~49岁),融合基因阳性者为3例,移植前获得完全缓解(CR)1患者为6例,无一例患者出现移植物抗宿主病(GVHD).单纯化疗组患者中位年龄为22岁(15~37岁),融合基因阳性者为4例,发生GVHD者为2例.②DSI联合化疗组患者中,常规化疗后接受单次DSI患者为5例,每2周输注1次DSI者为2例.DSI治疗后再次达CR者为3例(3/7).出现Ⅰ~Ⅱ度皮肤及肝急性GVHD(aGVHD)患者为4例,出现Ⅳ度骨髓抑制及肺炎者为3例.截至随访结束,DSI联合化疗组存活患者为1例,死亡患者为6例.③ 单纯化疗组患者中,常规化疗后获得CR者为3例(3/10).截至随访结束,存活患者为4例,死亡患者为6例.④DSI联合化疗组患者1、3年OS率分别为57.1%和19.0%,单纯化疗组1、3年OS率分别为66.7%和17.8%,2组分别比较,差异均无统计学意义(χ2=2.122、0.136,P=0.58、0.68).DSI联合化疗组和单纯化疗组患者1年SAR率比较,差异亦无统计学意义(41.3%比29.8%,χ2=3.165,P=0.43).结论 经G-CSF动员的亚标准剂量DSI联合化疗,可能提高allo-HSCObjective To investigate the clinical effect and prognosis of sub-standard dose of donor stem cell infusion (DSI ) mobilized by granulocyte colony-stimu1 ating factor (G-CSF ) in patients with relapsed acute leukemia (AL ) after allogeneic hematopoietic stem cell transplantation (allo-HSCT ). Methods From January 2010 to April 2017,a total of 17 patients with relapsed AL after allo-HSCT in Department of Hematology,the First Affiliated Hospital of Xi'an Jiaotong University were included in the study.They were divided into DSI combined chemotherapy group (n=7 )and chemotherapy alone group (n=10)according to different treatment after relapse.The basic clinical data of patients with relapsed AL after allo-HSCT were collected by retrospective analysis.The infusion dose of DSI,treatment results, adverse reactions and survival outcomes were observed in both groups.Kaplan-Meier method was used to draw the overall survival (OS)and survival after first relapse (SAR)curves of two groups.The OS and SAR rate were compared by Log-rank test between two groups.This study protocol was approved by the ethics committee of the First Affiliated Hospital of Xi'an Jiaotong University (Approoal No. XJTU1AF2010LSL-020 ). Informed consents were obtained from all patients before treatment. Results ① The median age of patients in DSI combined chemotherapy group was 28 years (11-49 years), 3 cases were positive in fusion gene,and 6 cases were achieved complete remission (CR )1 before transplantation,none of them had graft versus host disease (GVHD).The median age of patients in chemotherapy group was 22 years (15-37 years).The fusion gene was positive in 4 cases,and 2 cases had GVHD.② In DSI combined chemotherapy group, 5 patients received single DSI treatment after conventional chemotherapy,and 2 patients received DSI treatment in every two weeks.Three patients (3/7)achieved CR.There were 4 patients with grade Ⅰ ~Ⅱ aGVHD of skin and liver,3 patients with grade Ⅳ myelosuppression and pneumonia.Up to the end of follow-up,1 patient s

关 键 词：白血病 造血干细胞移植 复发 造血干细胞动员 供者干细胞输注 

分 类 号：R73[医药卫生—肿瘤]