亲缘间外周血异基因移植后白血病复发的危险因素分析  

Risk factors of leukemia relapse after interrelated peripheral blood allogeneic transplantation

作　　者：薛慧 李敏 刘志彬 胡永超 谢宗源 高峰 XUE Hui;LI Min;LIU Zhibin;HU Yongchao;XIE Zongyuan;GAO Feng(Department of Hematology,Affiliated Hospital of North China University of Science and Technology,Tangshan 063000,China)

机构地区：[1]华北理工大学附属医院血液科,河北唐山063000

出　　处：《大连医科大学学报》2023年第3期210-213,228,共5页Journal of Dalian Medical University

基　　金：河北省省级科技计划资助项目(22377738D);河北省医学科学研究课题计划项目(20210535)。

摘　　要：目的分析急慢性白血病患者行亲缘间、外周血异基因造血干细胞移植(Allo-HSCT)后复发的危险因素。方法选取2016年1月至2020年10月期间行Allo-HSCT的62例白血病患者为研究对象,其中急性髓系白血病(AML)30例,急性淋巴细胞白血病(ALL)24例,慢性粒细胞白血病(CML)8例。造血干细胞来源均为亲缘供者外周血,给予改良BU/CY±ATG清髓性预处理方案,统计移植后疾病复发情况,分析复发的危险因素。结果随访至2021年10月,中位随访时间为38(12~52)个月,共20例患者复发,总体复发率为32.3%(20/62),其中,AML复发率为33.3%(10/30),ALL复发率为37.5%(9/24),CML复发率为12.5%(1/8)。单因素分析显示,移植后复发的发生与患者性别、年龄、疾病类型、血型、人类白细胞抗原(HLA)配型、初诊时伴髓外病变、急性移植物抗宿主病(aGVHD)的发生、巨细胞病毒(CMV)感染无明显关系(P>0.05);与移植前微小残留病(MRD)水平、慢性移植物抗宿主病(cGVHD)的发生有关,移植前MRD阳性、移植后未并发cGVHD患者的复发率更高(P<0.05);多因素分析显示,移植前MRD水平是移植后复发的危险因素。结论移植前MRD阳性是亲缘间、外周血Allo-HSCT后复发的危险因素。Objective To analyze the risk factors of relapse in patients with acute and chronic leukemia after interrelated peripheral blood allogeneic hematopoietic stem cell transplantation(Allo-HSCT).Methods Total of 62 leukemia patients who underwent Allo-HSCT between January 2016 and October 2020 were enrolled in the study.Among them,30 patients had acute myeloid leukemia(AML),24 acute lymphocytic leukemia(ALL),and 8 chronic myeloid leukemia(CML).Hematopoietic stem cells were all derived from peripheral blood of related donors.The modified BU/CY±ATG myeloablative conditioning regimen was used prior to Allo-HSCT.Disease recurrence and its risk factors were analyzed.Results The patients were followed up until October 2021 with a median follow-up time of 38(12-52)months.A total of 20 patients relapsed with an overall relapse rate of 32.3%(20/62).Among them,AML was 33.3%(10/30),ALL 37.5%(9/24),CML 12.5%(1/8).Univariate analysis revealed no significant correlation between relapse and sex,age,disease type,blood type,human leukocyte antigen(HLA)matching,extramedullary disease at initial diagnosis,acute graft-versus-host disease(aGVHD),cytomegalovirus(CMV)infection(P>0.05).The relapse rate was significantly correlated with the level of minimal residual disease(MRD)before transplantation and the occurrence of chronic graft-versus-host disease(cGVHD).Patients with MRD before transplantation and without cGVHD after transplantation had a higher relapse rate(P<0.05).Multivariate analysis revealed that the level of MRD before transplantation was a risk factor for relapse(P<0.05).Conclusion Positive MRD before transplantation is a risk factor of leukemia relapse after interrelated peripheral blood Allo-HSCT.

关 键 词：外周血异基因移植 白血病 复发 危险因素 

分 类 号：R552[医药卫生—血液循环系统疾病]