成人急性淋巴细胞白血病自体造血干细胞移植后的维持治疗

Maintenance therapy after autologous hematopoietic stem cell transplantation for adult acute lymphoblastic leukemia

目的探讨成人急性淋巴细胞白血病(ALL)自体造血干细胞移植(ASCT)后维持治疗的可行性。方法第1次完全缓解期(CR1)进行ASCT成人ALL患者38例,预处理方案为全身照射+环磷酰胺(TBICy)方案或者TBICy联合其他化疗药物,ASCT后19例患者接受VP/MM方案维持化疗,13例间断IL蛳2治疗,其中8例联合IL蛳2和维持化疗。结果随访中位时间991(18～4914)d,复发11例,复发率28.9%,复发中位时间212(79～1008)d,其中8例在1年内复发,3年累积复发风险43.8%(95%可信限:35.1%～52.5%)。移植相关死亡(TRM)5例,TRM中位时间42(18～120)d,其中ASCT后接受维持治疗的24例患者仅2例发生TRM。3年和5年无白血病生存率均为55.7%(95%可信限:47.3%￣64.1%)。结论成人ALL患者ASCT后标准方案维持化疗和免疫治疗安全有效,能够减低移植后复发风险,提高ASCT的疗效。

Objective To explore the feasibility of post- autotransplant maintenance therapy in adult acute lymphoblastic leukemia (ALL). Methods The preparative regimen were total body irradiation and cyclophosphamide with or without other chemotherapeutic agents for 38 adult patients receiving autografts in first remission. In an attempt to reduce relapse rate, 19 patients received vincristine- prednisone (VP) and 6- mercaptopurine- methotrexate (MM) and 13 intermittently received interleukin- 2 (IL- 2) after transplant. Among them, 8 patients received VP / MM and IL- 2. Results After a median 990.5 days (range, 18 ～ 4 914 ) of follow- up, eleven patients had a relapse at 79 to 1008 days (median, 212 days), 8 in first year. The cumulative incidence of relapse at 3 years was 43.8 % (95 %CI, 35.1 % ~ 52.5 %). Five died due to transplant- related causes at 18 to 120 days (median, 42 days), 2 in 24 received post- transplant therapy. The probability of disease- free survival (DFS) was 55.7 % (95 %CI, 47.3 % ~ 64.1 %) at 3- year and 5- year. Conclusions Our data suggest that standard ALL- type maintenance chemotherapy and IL- 2 can be administered safely after autotransplantation and improve the outcome of adult ALL patients with undergoing autografting by reducing relapse.