异基因造血干细胞移植治疗老年人急性髓系白血病预后分析  

Prognostic analysis of allogeneic hematopoietic stem cell transplantation in treatment of elderly patients with acute myeloid leukemia

作　　者：张文丽 侯畅 单蒙 刘吟[1] 王栋 程巧 徐杨[1] 吴德沛[1] Zhang Wenli;Hou Chang;Shan Meng;Liu Yin;Wang Dong;Cheng Qiao;Xu Yang;Wu Depei(Department of Hematology,the First Affiliated Hospital of Soochow University,Jiangsu Institute of Hematology,Key Laboratory of Thrombosis and Hemostasis of Ministry of Health,Collaborative Innovation Center of Hematology,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院血液科江苏省血液研究所卫生部血栓与止血重点实验室血液学协同创新中心,215006

出　　处：《白血病．淋巴瘤》2020年第1期30-36,共7页Journal of Leukemia & Lymphoma

基　　金：国家重点研发计划(2017YFA0104502、2017ZX09304021);江苏省医学杰出人才项目(JCRC2016002);江苏省创新能力建设专项(BM2015004);江苏省科教强卫工程-临床医学中心(YXZXA2016002)。

摘　　要：目的 评估异基因造血干细胞移植(allo-HSCT)治疗老年人急性髓系白血病(AML)的预后。方法 回顾性分析2008年6月至2019年3月于苏州大学附属第一医院接受allo-HSCT的53例年龄≥55岁AML患者的临床资料,其中单倍体移植26例,同胞全相合移植18例,无关供者移植9例。分析老年AML患者行allo-HSCT的疗效,并比较单倍体与同胞全相合移植的疗效及安全性。结果 53例老年AML患者中男性35例,女性18例,中位年龄57岁(55~67岁)。45例采用清髓性预处理(MAC)方案,8例采用减低剂量预处理(RIC)方案。52例患者粒系植入成功,植入中位时间12 d(10~23 d);50例患者巨核系植入成功,植入中位时间为13 d(10~76 d)。急性移植物抗宿主病(GVHD)的发生率为49.1%(26/53),其中Ⅲ~Ⅳ级15.1%(8/53)。中位随访时间14.7个月(0.4~136.8个月),生存32例。2年总生存(OS)率、2年无病生存(DFS)率、2年无GVHD无复发生存(GRFS)率分别为63.1%、59.5%和46.1%。多因素分析显示移植前疾病处于非完全缓解状态是影响患者OS(HR=3.600,95%CI 1.213~10.684,P=0.021)、DFS(HR=2.596,95% CI 1.098~6.138,P=0.030)及复发(HR=3.957,95%CI 1.099~14.245,P=0.035)的独立危险因素,移植时供者年龄>45岁是影响患者OS(HR=3.687,95%CI 1.343~10.215,P=0.011)的独立危险因素,诊断至移植时间≥6个月是影响患者GRFS(HR=2.308,95%CI 1.083~4.918,P=0.030)的独立危险因素。单倍体移植组与同胞全相合移植组OS率、DFS率、累积复发率、Ⅲ~Ⅳ级急性GVHD及中重度慢性GVHD发生率差异均无统计学意义(均P>0.05)。结论 allo-HSCT是老年人AML安全有效的治疗方式,单倍体移植治疗老年人AML具有与同胞全相合移植相似的疗效及安全性,在无全相合供者情况下,单倍体造血干细胞移植可作为一个较好的选择。Objective To evaluate the prognosis of allogeneic hematopoietic stem cell transplantation(allo-HSCT)for treatment of elderly patients with acute myeloid leukemia(AML).Methods The clinical data of 53 elderly patients(≥55 years old)with AML who received allo-HSCT in the First Affiliated Hospital of Soochow University from June 2008 to March 2019 were retrospectively analyzed.All the patients included haplo-HSCT(26 cases),matched-sibling donors(MSD)-HSCT(18 cases),matched or mismatched unrelated donors(9 cases).The efficacy of allo-HSCT for elderly patients with AML was analyzed,and the efficacy and safety of haplo-HSCT and MSD-HSCT were compared.Results There were 35 males and 18 females among 53 elderly AML patients.The median age was 57 years old(55-67 years old),and 45 patients received myeloablative conditioning(MAC)regimen while 8 patients received reduced intensity conditioning(RIC)regimen.There were 52 patients who were successfully implanted in granulocyte,and the median time for engraftment was 12 d(10-23 d).There were 50 patients who were successfully implanted in megakaryocyte and the median time for engraftment was 13 d(10-76 d).The incidence of acute graft-versus-host disease(GVHD)was 49.1%(26/53),and the incidence of gradeⅢ-Ⅳacute GVHD was 15.1%(8/53),respectively.The median follow-up time was 14.7 months(0.4-136.8 months),and 32 patients survived.The rate of 2-year overall survival(OS),disease-free survival(DFS)and graft-versus-host-free-relapse free survival(GRFS)was 63.1%,59.5%and 46.1%,respectively.Multivariate analysis showed that non-complete remission(CR)state before transplantation was an independent prognostic factor for OS(HR=3.600,95%CI 1.213-10.684,P=0.021),DFS(HR=2.596,95%CI 1.098-6.138,P=0.030)and relapse(HR=3.957,95%CI 1.099-14.245,P=0.035).Donor age>45 years old was an independent risk factor for OS(HR=3.687,95%CI 1.343-10.215,P=0.011).Time from diagnosis to transplantation≥6 months was an independent risk factor for GRFS(HR=2.308,95%CI 1.083-4.918,P=0.030).There were no statis

关 键 词：白血病 髓样 急性 老年人 造血干细胞移植 预后 

分 类 号：R733[医药卫生—肿瘤]