急性白血病患者第一次完全缓解期自体和异基因造血干细胞移植疗效的比较

Comparison of autologous and allogeneic hematopoietic stem cell transplantation for 140 patients with de novo acute leukemia in first complete remission

目的 对急性白血病 (AL) (不包括急性髓系白血病M3 型 )患者第 1次完全缓解 (CR1)期自体造血干细胞移植 (auto HSCT)和异基因造血干细胞移植 (allo HSCT)的疗效进行比较。方法 AL CR1期HSCT患者 14 0例 ,其中HLA相合同胞供者allo HSCT 4 6例 ,auto HSCT 94例 ,预处理方案包括全身照射 +环磷酰胺 (TBICy)、白消安 +环磷酰胺 (BuCy)以及马法兰 +阿糖胞苷 +环磷酰胺(MAC)方案。allo HSCT组予以环孢菌素A(CsA)或联合甲氨蝶呤 (MTX)或FK5 0 6预防移植物抗宿主病 (GVHD) ,auto HSCT组自体骨髓净化 39例 ,移植后免疫治疗和 (或 )维持化疗 38例。结果 14 0例患者移植后均获髓系造血重建 ,中位随访时间 70 0 (18～ 5 5 6 3)d ,auto HSCT组与allo HSCT组比较 :移植后 5年无白血病生存 (LFS)率 [分别为 (5 1.5± 5 .4 ) %和 (5 2 .8± 7.6 ) % ]相近 (P >0 .0 5 ) ;累积移植相关死亡率 [分别为 (14 .4± 4 .1) %和 (37.6± 7.8) % ]后者显著增高 (P <0 .0 5 ) ;累积复发率 [分别为 (5 2 .0± 5 .5 ) %和 (2 6 .3± 6 .9) % ]前者明显增加 ,但无显著性差异 (P >0 .0 5 )。auto HSCT组中自体骨髓净化和移植后治疗患者与未经相应处理患者比较 ,5年LFS率显著提高 ,分别为 (6 2 .8± 6 .8) %和 (38.4± 8.4 ) % ,P

Objective To evaluate the outcome of patients with de novo acute leukemia (AL,no AML M 3) in CR 1 undergone autologous hematopoietic stem cell transplantation (auto HSCT) or HLA identical sibling allogeneic HSCT (allo HSCT). Methods Forty six AL patients received allo HSCT and 94 received auto HSCT in CR 1. The conditioning regimens mainly consisted of TBICy, BuCy and MAC. Cyclosporine plus methotrexate, or cyclosporine alone, or FK506 alone was used for graft versus host disease (GVHD) prophylaxis. Among auto HSCT group, 39 patients received purged autologous bone marrow and 38 received immunotherapy and/or maintenance chemotherapy after transplant. Results Myeloid reconstitution was achieved in all patients. After a median of 700 (range, 18～5563 ) days follow up, the probabilities of leukemia free survival (LFS) at 5 year were not significantly different in these two groups: (51.5±5.4)% for auto HSCT group and (52.8±7.6)% for allo HSCT group(P>0.05). There was a lower cumulative relapse incidence (RI) \[(26.3±6.9)% vs. ( 52.0 ± 5.5 )%, P>0.05\] but a significantly higher cumulative transplant related mortality (TRM) \[(37.6±7.8% vs. (14.4±4.1)%, P<0.05\] in the allo HSCT group than in auto HSCT group. Among auto HSCT group, the patients received purged autografts and/or post transplant therapy had significantly better LFS and lower RI (P<0.05)than those received unpurged autografts or no post transplant treatments \[5 y LFS: (62.8±6.8)% and (38.4±8.4)%; RI: (37.7±6.8)% and (74.2±8.7)% ,respectively\]. Conclusion The long term LFS of auto HSCT was comparable to that of allo HSCT in the management of patients with AL in CR 1, because autograft purging and post transplant treatment can significantly decrease relapse of auto HSCT patients and auto HSCT has lower therapy related toxicities.