自体与同胞全相合造血干细胞移植治疗Ph^+急性淋巴细胞白血病的疗效比较  

Comparison of autologous versus matched sibling donor stem cell transplantation for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia

作　　者：吕梦楠 姜尔烈 何祎 杨栋林 马巧玲 庞爱明 翟卫华 魏嘉璘 黄勇 张桂新 张荣莉 冯四洲 韩明哲 Lyu Mengnan;Jiang Erlie;He Yi;Yang Donglin;Ma Qiaoling;Pang Aiming;Zhai Weihua;Wei Jialin;Huang Yong;Zhang Guixin;Zhang Rongli;Feng Sizhou;Han Mingzhe(Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,State Key Laboratory of Experimental Hematology,National Clinical Research Center for Blood Diseases,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),实验血液学国家重点实验室,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373-378,共6页Chinese Journal of Hematology

摘　　要：目的比较自体造血干细胞移植(auto-HSCT)和同胞全相合造血干细胞移植(MSD-HSCT)治疗费城染色体阳性急性淋巴细胞白血病(Ph+ALL)的疗效,为患者移植方式的选择提供依据。方法回顾性总结2008年1月至2017年12月于中国医学科学院血液病医院行auto-HSCT(31例)及MSD-HSCT(47例)的78例Ph+ALL患者的临床特征,比较不同移植方式患者的总生存(OS)率、无白血病生存(LFS)率、累积复发率(CIR)及非复发死亡率(NRM),并观察是否3个月内实现完全分子学缓解并持续至移植(s3CMR)条件下不同移植方式对预后的影响。结果auto-HSCT组、MSD-HSCT组粒细胞植入的中位时间分别为12(10~29)d、14(11~24)d(P=0.006),血小板植入的中位时间分别为17.5(10~62)d、17(10~33)d(P=0.794)。MSD-HSCT组中,Ⅱ~Ⅳ度和Ⅲ~Ⅳ度急性移植物抗宿主病(GVHD)的发生率分别为27.7%(13/47)和8.5%(4/47),局限型和广泛型慢性GVHD的发生率为17.0%(8/47)和12.8%(6/47)。auto-HSCT组、MSD-HSCT组3年CIR、NRM、LFS率差异均无统计学意义(P值均>0.05)。在达到s3CMR的44例患者中,auto-HSCT组和MSD-HSCT组的3年OS率[(84.0±8.6)%对(78.0±8.7)%,P=0.612]、LFS率[(70.3±10.3)%对(68.2±10.1)%,P=0.970]、CIR[(24.9±10.0)%对(14.4±8.0)%,P=0.286]和NRM[(4.7±4.7)%对(17.4±8.1)%,P=0.209]差异均无统计学意义;未达到s3CMR的34例患者中,auto-HSCT组与MSD-HSCT组相比,3年CIR明显升高[(80.0±14.7)%对(39.6±10.9)%,P=0.057]。结论对于化疗后达s3CMR的Ph+ALL患者,auto-HSCT是一种有效的巩固治疗选择,与MSD-HSCT疗效相当;对于未达到s3CMR的患者,MSD-HSCT复发率更低。Objective To compare the efficacy of autologous HSCT(auto-HSCT)with matched sibling donor(MSD)HSCT in Ph+ALL and provide a basis for the choice of transplantation method.Methods We retrospectively investigated the outcomes of 78 adult patients with Ph+ALL who underwent auto-HSCT(n=31)and MSD-HSCT(n=47)in Institute of Hematology and Blood Diseases Hospital,CAMS&PUMC,from January 2008 to December 2017.The overall survival(OS)rate,leukemia-free survival(LFS)rate,cumulative incidence of relapse(CIR)rate,nonrelapse mortality(NRM)rate,and the impact of achievement of complete molecular response(CMR)within 3 months and sustaining CMR up to transplantation(s3CMR)on transplantation method were explored.Results The median time of neutrophil and platelet reconstitution in auto-HSCT and MSD-HSCT groups were 12(10-29)days vs14(11-24)days(P=0.006)and 17.5(10-62)days vs 7(10-33)days(P=0.794),respectively.In the MSD-HSCT group,the incidence ofⅡ-ⅣandⅢ-Ⅳacute graft-versus-host disease(GVHD)was 27.7%(13/47)and 8.5%(4/47),respectively.The incidence of limited and extensive chronic GVHD was 17.0%(8/47)and 12.8%(6/47),respectively.The estimated CIR,NRM,LFS,and OS at 3 years were not significantly different between auto-HSCT and MSD-HSCT groups(P>0.05).For 44 patients who achieved s3CMR,3-year OS[(84.0±8.6)%vs(78.0±8.7)%,P=0.612],LFS[(70.3±10.3)%vs(68.2±10.1)%,P=0.970],CIR[(24.9±10.0)%vs(14.4±8.0)%,P=0.286],and NRM[(4.7±4.7)%vs(17.4±8.1)%,P=0.209]of the auto-HSCT and MSD-HSCT groups were not significantly different.However,for 34 patients who did not reach s3CMR,3-year cumulative relapse rate of patients in the auto-HSCT group was significantly higher than MSD-HSCT group[(80.0±14.7)%vs(39.6±10.9)%,P=0.057].Conclusions auto-HSCT with maintenance therapy after HSCT appears to be an attractive treatment option for patients with Ph+ALL especially for those with s3CMR maintained up to transplantation.For non-s3CMR patients,allogeneic transplantation may be more effective from lower relapse.

关 键 词：费城染色体阳性急性淋巴细胞白血病 异基因造血干细胞移植 自体造血干细胞移植 完全分子学缓解 

分 类 号：R733.71[医药卫生—肿瘤]