外周血造血干细胞移植治疗成人急性淋巴细胞白血病的预后分析  

Prognostic analysis of peripheral blood stem cell transplantation in the treatment of adult acute lymphoblastic leukemia

作　　者：薛慧 李敏 胡永超 刘志彬 谢宗源 高峰 XUE Hui;LI Min;HU Yongchao;LIU Zhibin;XIE Zongyuan;GAO Feng(Department of Hematology,North China University of Science and Technology Afiliated Hospital,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》2024年第2期115-119,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重点课题计划(20210535)。

摘　　要：目的 探讨单纯外周血异基因造血干细胞移植(Allo-HSCT)治疗成人急性淋巴细胞白血病(ALL的复发及生存情况。方法 回顾性分析2017年1月至2022年6月化疗后获首次血液学完全缓解(CR1)的52例ALL患者的临床资料,所有患者均给予改良BU/CY±ATG清髓性预处理方案,造血干细胞均来源于亲缘间供者外周血,观察移植相关并发症,分析移植后血液学复发的危险因素及生存情况。结果 白细胞重建时间为14(10~19)d,血小板重建时间为16(11~25)d, 18例(34.6%)出现急性移植物抗宿主病(aGVHD)、15例(28.8%)出现慢性移植物抗宿主病(cGVHD)、33例(63.5%)出现巨细胞病毒(CMV)感染、10例(19.2%)出现出血性膀胱炎。单因素分析提示,Allo-HSCT后复发与患者性别、年龄、血型、人类白细胞抗原(HLA)配型、GVHD的发生、CMV感染、出血性膀胱炎无关(P>0.05);与移植前微小残留病(MRD)水平有关,移植前MRD阳性者复发率更高(P<0.05)。随访至2023年6月,中位随访时间38(4~69)月,3年累积复发率、无病生存率(DFS)、总生存率(OS)分别为31.6%、56.7%、64.3%;5年累积复发率、DFS、OS分别为37.3%、52.0%、59.0%。结论 亲缘间外周血Allo-HSCT可以明显提高ALL患者临床疗效,移植前MRD阳性有更高的复发率。Objective To study the recurrence and survival status of allogeneic hematopoietic stem cell transplantation(Allo-HSCT)in the treatment of adult acute lymphoblastic leukemia(ALL).Methods A retrospective analysis was conducted on clinical data of 52 ALL patients who achieved complete hematological remission(CR1)after chemotherapy from January 2017 to June 2022.A modified BU/CY+ATG myeloablative pretreatment regimen was administered,and hematopoietic stem cells were derived from peripheral blood of related donors.Transplant related complications were reviewed,and risk factors for hematological relapse and survival status were analyzed.Results The white blood cell reconstruction time was 14(10-19)days,and the platelet reconstruction time was 16(11-25)days.After transplantation,18 cases(34.6%)developed acute grafft-versus-host disease(aGVHD),15 cases(28.8%)developed chronic graft-versus-host disease(cGVHD),33 cases(63.5%)had cytomegalovirus(CMV)infection,and 10 cases(19.2%)developed hemorrhagic cystitis.Univariate analysis revealed that recurrence after Allo-HSCT was not related to patient gender,age,blood type,human leukocyte antigen(HLA)typing,occurrence of GVHD,CMV infection,or hemorrhagic cystitis(P>0.05),but was associated with the degree of minimal residual disease(MRD)before transplantation,with a higher recurrence rate in MRD positive cases(P<0.05).The patients were followed up until June 2023,with a median time of 38(4-69)months.The 3-year cumulative recurrence rate,disease-free survival(DFS)and overall survival(OS)were 31.6%,56.7%,64.3%,respectively;and the 5-year cumulative recurrence rate,DFS and OS were 37.3%,52.0%,59.0%,respectively。Conclusion Allo-HSCT from related donors can significantly improve the clinical outcome of ALL patients.Patients positive for MRD before transplantation have a higher recurrence rate.

关 键 词：急性淋巴细胞白血病 外周血 造血干细胞移植 预后 

分 类 号：R552[医药卫生—血液循环系统疾病]