非高危急性髓系白血病患者首次完全缓解后行自体与异基因外周血造血干细胞移植的疗效对比  

Efficacy of autologous versus allogeneic peripheral blood hematopoietic stem cell transplantation in non-high-risk acute myeloid leukemia patients in first complete remission

作　　者：肖函 王欣[1] 罗小华[1] 肖青[1] 张红宾[1] 唐晓琼[1] 刘林[1] 陈建斌[1] 杨泽松[1] 王利[1] XIAO Han;WANG Xin;LUO Xiaohua;XIAO Qing;ZHANG Hongbin;TANG Xiaoqiong;LIU Lin;CHEN Jianbin;YANG Zesong;WANG Li(Department of Hematology,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China)

机构地区：[1]重庆医科大学附属第一医院血液内科,重庆400016

出　　处：《第三军医大学学报》2020年第17期1717-1723,共7页Journal of Third Military Medical University

基　　金：重庆市科卫联合医学科研重点项目(2018ZDXM001);重庆渝中区科技计划项目(20190121)。

摘　　要：目的比较非高危急性髓系白血病(acute myeloid leukemia,AML)患者获得首次完全缓解(first complete remission,CR1)后行自体和异基因外周血造血干细胞移植(peripheral blood hematopoietic stem cell transplantation,PB-HCT)的疗效。方法纳入本院2012年1月至2019年6月接受PB-HCT的73例CR1期非高危AML患者,49例行异基因PB-HCT(异基因移植组),24例行自体PB-HCT(自体移植组)。比较两组的造血重建时间、输血需求量及早期感染次数、1年累积复发率(relapse incidence,RI)及非复发死亡率(non-relapse mortality,NRM)、1年总体生存率(overall survival,OS)和无白血病生存率(leukemia-free survival,LFS)。结果两组患者的造血重建时间、输血需求量、早期感染次数差异无统计学意义(P>0.05)。自体移植组和异基因移植组的1年RI分别为25.4%和6.2%(P<0.01);1年NRM分别为0.0%和8.3%(P=0.15);1年OS分别为95.8%和89.5%(P=0.80);1年LFS分别为74.6%和85.6%(P=0.07)。低危患者中,两组的RI、NRM、LFS和OS差异无统计学意义(P>0.05)。中危患者中,自体移植组和异基因移植组的NRM和OS差异无统计学意义(P>0.05),1年RI分别为31.6%vs 8.8%(P<0.01),1年LFS分别为68.4%和85.3%(P=0.02)。行同胞全相合移植的中危患者LFS高于自体移植组(90.5%vs 68.4%,P<0.01),而行单倍体相合移植的中危患者LFS与自体移植差异无统计学意义(P>0.05)。结论低危CR1期AML患者接受自体和异基因PB-HCT疗效相似;中危患者行异基因PB-HCT疗效更佳,但其优势仅来源于同胞全相合移植,如缺乏同胞全相合供体,自体移植也是有效替代方法。Objective To compare the efficacy of autologous and allogeneic peripheral blood hematopoietic stem cell transplantation(PB-HCT)for non-high-risk acute myeloid leukemia(AML)patients having achieved first complete remission(CR1).Methods A total of 73 patients with CR1 stage AML(non-high risk)who underwent PB-HCT in our department from January 2012 to June 2019 were enrolled in this study,and they were 49 patients receiving allogeneic PB-HCT and 24 getting autologous PB-HCT.The time of hematopoietic reconstruction,required transfusion volume,the number times of early infections,1-year cumulative relapse incidence(RI)and non-relapse mortality(NRM),1-year overall survival(OS)and leukemia-free survival(LFS)were compared between the 2 groups.Results There were no significant differences in hematopoietic reconstruction time,required transfusion volume and the number times of early infections between the 2 groups.As for the autologous PB-HCT group and allogeneic PB-HCT group,1-year RI was 25.4%and 6.2%(P<0.01);1-year NRM was 0.0%and 8.3%(P=0.15);1-year OS was 95.8%and 89.5%(P=0.80);and 1-year LFS was 74.6%and 85.6%(P=0.07),respectively.Among the low-risk patients,there were no obvious differences in RI,NRM,LFS,and OS between the 2 groups.For the intermediate-risk patients,1-year NRM and OS were not significantly different,1-year RI was 31.6%and 8.8%(P<0.01),and 1-year LFS was 68.4%and 85.3%(P=0.02),respectively.Furthermore,the intermediate-risk patients who received MSD(HLA-matched sibling donor)PB-HCT had higher LFS than the autologous group(90.5%vs 68.4%,P<0.01),while the LFS of the patients undergoing haploid-identical PB-HCT was not statistically different from autologous PB-HCT.Conclusion Autologous and allogeneic PB-HCT can result in a similar effect in the low-risk AML patients at the CR1 stage.Moreover,allogeneic PB-HCT is more effective for intermediate-risk patients,but only for the patients undergoing MSD PB-HCT.If there is a lack of HLA-matched sibling donor,autologous PB-HCT is an effective alternative.

关 键 词：急性髓系白血病 首次完全缓解 自体移植 异体移植 

分 类 号：R392.11[医药卫生—免疫学] R617[医药卫生—基础医学]