新单倍体不合二次造血干细胞移植的临床预后分析  

Second hematopoietic stem cell transplantation with a new haploid-mismatched donor in relapsed patients after first transplantation:prognostic analysis of 11 cases

作　　者：朱盼盼 吴一波 刘丽珍[1] 来晓瑜[1] 施继敏[1] 黄河[1] 罗依[1] ZHU Panpan;WU Yibo;LIU Lizhen;LAI Xiaoyu;SHI Jimin;HUANG He;LUO Yi(Bone Marrow Transplantation Center,First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou,Zhejiang Province,310003,China)

机构地区：[1]浙江大学医学院附属第一医院骨髓移植中心,浙江大学血液学研究所,杭州310003

出　　处：《第三军医大学学报》2021年第21期2294-2301,共8页Journal of Third Military Medical University

摘　　要：目的探讨新单倍体不合供者作为二次移植替代供者的移植方案治疗血液系统恶性肿瘤异基因造血干细胞移植(allogenetic hematopoietic stem cell transplantation,allo-HSCT)后复发患者的临床预后。方法回顾性分析2013年10月至2021年6月在浙江大学医学院附属第一医院行新单倍体不合二次移植的11例血液系统恶性肿瘤患者的临床资料。患者均在原发病完全缓解(complete remission,CR)状态下行二次造血干细胞移植,其中6例患者在二次移植后接受供者淋巴细胞输注(donor lymphocyte infusion,DLI)。随访观察患者的临床预后,初步探索新单倍体不合二次移植的疗效。结果11例患者中位随访9.4(2.9~94.9)个月,3例患者半相合二次移植后因复发而死亡,1例因肺部感染而死亡,余7例均处于原发病缓解生存。二次移植后1年总体生存率(overall survival,OS)为77.9%(95%CI:54.6%~99.9%),无白血病生存率(leukemia-free survival,LFS)为77.9%(95%CI:54.6%~99.9%);半相合二次移植联合DLI的1年OS为83.3%(95%CI:58.3%~99.9%)。二次移植后患者的1年累积复发率为22.1%。结论新单倍体不合二次移植治疗allo-HSCT后复发患者可行;且不显著增加治疗相关的死亡,具有一定的安全性。Objective To investigate the clinical outcome of the patients with hematologic malignancy recurrence following first allogenetic hematopoietic stem cell transplantation(allo-HSCT)and receiving second transplantation from an alternative haploid-mismatched donor.Methods We retrospectively reported the clinical data of 11 patients with hematologic malignancies who underwent a second HSCT using a new haploidentical related donor(HRD)in our center between October 2013 and June 2021.At the second transplantation,all patients were in complete remission(CR).Six of them received donor lymphocyte infusion(DLI)after the second transplantation.The clinical prognosis of the patients was followed up to primarily explore the effect of secondary transplantation.Results The median follow-up was 9.4(2.9~94.9)months.Of the 11 relapsed patients,3 patients died of disease relapse and 1 patient died of lung infection,and the remaining 7 patients survived with CR.The 1-year overall survival(OS)rate was 77.9%(95%CI:54.6%~99.9%),so was 1-year leukemia-free survival(LFS)rate.For the 6 patients receiving DLI,the 1-year OS rate was 83.3%(95%CI:58.3%~99.9%).The cumulative incidence of relapse was 22.1%in the 11 patients.Conclusion A second HSCT using a new haploid-mismatched donor is a feasible strategy for the patients with hematologic malignancy recurrence after the first transplantation.It has no significant increase in treatment-related death,and shows a certain safety.

关 键 词：二次移植 供者淋巴细胞输注 血液系统恶性肿瘤 复发 

分 类 号：R617[医药卫生—外科学] R730.7[医药卫生—临床医学]