自体与无关供者造血干细胞移植治疗首次缓解期成人原发性急性髓系白血病的疗效比较  

Autologous versus unrelated donor stem cell transplantation for adults with primary acute myeloid leukemia in first remission

作　　者：姚剑峰 张桂新 杨栋林 何祎 魏嘉璘 翟卫华 姜尔烈 张荣莉 冯四洲 韩明哲 Yao Jianfeng;Zhang Guixin;Yang Donglin;He Yi;Wei Jialin;Zhai Weihua;Jiang Erlie;Zhang Rongli;Feng Sizhou;Han Mingzhe(National Clinical Research Center for Blood Diseases,Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Tianjin 300020,China)

机构地区：[1]中国医学科学院血液病医院(中国医学科学院血液学研究所),国家血液系统疾病临床医学研究中心,天津300020

出　　处：《中华血液学杂志》2020年第5期365-372,共8页Chinese Journal of Hematology

基　　金：国家自然科学基金(81670171、81700166、81700115);国家自然科学基金青年科学基金(81900182)天津市自然科学基金(18JCZDJC34400);中国医学科学院医学与健康科技创新工程(2016-I2M-3-023)。

摘　　要：目的分析自体造血干细胞移植(auto-HSCT)与无关供者造血干细胞移植(URD-HSCT)治疗首次完全缓解期(CR1)成人原发性急性髓系白血病(AML)的疗效,比较并探讨两种移植方式的差异及适应人群。方法对2008年3月至2018年11月在中国医学科学院血液病医院接受auto-HSCT及URD-HSCT的成人原发性AML患者进行回顾性分析。结果共纳入147例患者,其中auto-HSCT组87例,URD-HSCT组60例,两组病例基线特征基本一致。auto-HSCT组、URD-HSCT组+30 d粒细胞植活率差异无统计学意义[92.6%(95%CI 86.9%~98.3%)对98.3%(95%CI 95.0%~100.0%),P=0.270],auto-HSCT组+60 d血小板累积植活率低于URD-HSCT组[83.6%(95%CI 75.8%~91.4%)对93.3%(95%CI 87.0%~99.6%),P<0.001]。URD-HSCT组急性GVHD累积发生率为56.7%(95%CI 43.0%~68.2%),Ⅱ~Ⅳ度急性GVHD累积发生率为16.7%(95%CI 8.5%~27.2%),慢性GVHD累积发生率为33.3%(95%CI 21.7%~45.4%),广泛型慢性GVHD累积发生率为15.0%(95%CI 7.3%~25.2%)。中位随访53.8(0.8~127.8)个月,auto-HSCT组、URD-HSCT组5年总生存(OS)率分别为71.7%(95%CI 61.7%~81.7%)、67.8%(95%CI 55.8%~79.8%)(P=0.556),无白血病生存(LFS)率分别为64.6%(95%CI 54.4%~74.8%)、68.1%(95%CI 56.3%~79.9%)(P=0.642)。auto-HSCT组5年累积复发率高于URD-HSCT组[31.9%(95%CI 22.2%~42.1%)对15.1%(95%CI 7.4%~25.6%),P=0.015],移植相关死亡率(TRM)低于URD-HSCT组[3.4%(95%CI 0.9%~8.9%)对16.7%(95%CI 8.5%~27.2%),P=0.006]。HLA相合及不全相合的无关供者移植在造血重建、GVHD、OS、LFS、复发及TRM方面差异均无统计学意义。遗传学低、中危患者auto-HSCT、URD-HSCT组移植后OS率、LFS率差异均无统计学意义,高危患者auto-HSCT后累积复发率高于URD-HSCT,LFS率低于URD-HSCT。结论对于成人原发性AML-CR1患者,auto-HSCT与URD-HSCT具有相似的OS率和LFS率,auto-HSCT组复发率较高而TRM较低。缺乏同胞供者的遗传学高危组患者应选择URD-HSCT以减少移植后复发,提高生存率。Objective To compare differences of autologous and unrelated donor stem cell transplantation(auto-HSCT and URD-HSCT)for adults with primary acute myeloid leukemia(AML)in first complete remission(CR1)from a single center and to investigate the appropriate patients for the 2 types of transplant.Methods In this retrospective investigation,we studied adults with primary AML who received auto-HSCT and URD-HSCT from March 2008 to November 2018.Overall survival(OS),leukemia-free survival(LFS),relapse,transplant-related mortality(TRM),and hematopoietic reconstitution were compared along with the prognostic value of cytogenetics.Results A total of 147 adult patients were enrolled in this study(n=87 for auto-HSCT and n=60 for URD-HSCT).Baseline characteristics were comparable between the 2 groups.The accumulative neutrophil engraftment rate at+30 days was not statistically different between the 2 groups[92.6%(95%CI 86.9%-98.3%)vs 98.3%(95%CI 95.0%-100.0%),P=0.270],whereas the accumulative platelet engraftment rate at+60 days was significantly lower in the auto-HSCT group[83.6%(95%CI 75.8%-91.4%)vs 93.3%(95%CI 87.0%-99.6%),P<0.001].In patients undergoing URD-HSCT,the accumulative incidences of acute GVHD(aGVHD)and gradeⅡ-ⅣaGVHD were 56.7%(95%CI 43.0%-68.2%)and 16.7%(95%CI 8.5%-27.2%),and the incidences of chronic GVHD(cGVHD)and extensive cGVHD were 33.3%(95%CI 21.7%-45.4%)and 15.0%(95%CI 7.3%-25.2%),respectively.After a median follow-up of 53.8(0.8-127.8)months,patients in the 2 groups demonstrated comparable OS and LFS at 5 years after transplant[71.7%(95%CI 61.7%-81.7%)vs 67.8%(95%CI 55.8%-79.8%),P=0.556;64.6%(95%CI 54.4%-74.8%)vs 68.1%(95%CI 56.3%-79.9%),P=0.642].Patients in the auto-HSCT group showed significantly higher incidence of relapse at 5 years after transplant[31.9%(95%CI 22.2%-42.1%)vs 15.1%(95%CI 7.4%-25.6%),P=0.015]and significantly lower incidence of TRM[3.4%(95%CI 0.9%-8.9%)vs 16.7%(95%CI 8.5%-27.2%),P=0.006]compared with the URD group.HLA mismatching had no effects on the incidences of hematopoietic r

关 键 词：急性髓系白血病 自体造血干细胞移植 无关供者造血干细胞移植 细胞遗传学 

分 类 号：R733.71[医药卫生—肿瘤]