中/大剂量阿糖胞苷方案序贯化疗后自体造血干细胞移植治疗成年人急性白血病69例分析

Intensive intermediate/high-dose cytarabine-based chemotherapy followed by autologous stem cell transplantation for 69 adult acute leukemia patients in first remission

目的观察第1次完全缓解(CR1)期成年人急性白血病(AL)患者中/大剂量阿糖胞苷(I/HIDAC)序贯强烈化疗后自体造血干细胞移植(ASCT)的安全性及移植疗效。方法回顾性分析CR1期无HLA匹配同胞供者的成年人AL患者,早期接受I/HIDAC序贯强烈化疗并ASCT治疗。观察其毒副作用、移植相关死亡率(TRM)及总生存率(OS)和无白血病生存率(LFS)等。结果69例患者接受I/HIDAC强化治疗中位2(1￣3)疗程。患者均发生WHOⅢ￣Ⅳ级造血系统毒性,常见的非造血系统毒性为胃肠道、皮肤、黏膜毒性、发热及感染等,多为轻微到中等程度。患者均采集到足量的骨髓和/或外周血干细胞。1例预处理后早期死亡,余患者移植后均完全造血重建。中位随访80.5个月,TRM10.14%。预期移植后5年OS在AML和ALL分别为(55.36±3.69)%和(56.90±3.56)%,而5年LFS分别为(55.51±3.70)%和(58.09±3.14)%。结论成年人AL在取得CR1后早期进行以I/HIDAC为基础的强化/巩固治疗后进行ASCT,患者耐受性良好,可获得较好的长期OS和LFS。

Objective We report our outcome of the intensive intermediate/high-dose cytarabine（I/ HIDAC） based chemotherapy followed by autologous stem cell transplantation （ASCT） for adult acute leukemia patients in the first remission （CR1）. Methods 69 adult acute leukemia patients in CR1 without HLA-matched sibling received I/HIDAC based intensive chemotherapy followed by ASCTo The treatment-related morbidity, transplantation-related mortality （TRM）, overall survive （OS） and leukemia-free survival （LFS） were evaluated to assess the feasibility and the curative effect of the therapeutic strategies. Results There were 32 patients with acute myeloid leukemia（AML） and 37 patients with acute lymphoblastic leukemia （ALL） finished treatment with the above protocol. Every patient had received a median of 2（1-3） courses of I/ HIDAC based chemotherapy before ASCT. All patients had WHO Ⅲ-Ⅳ grade myelosuppression. The major non-hematological complication were nausea/vomiting, hepatic dysfunction,rash,mucositis,ara-C-induced fever and infecton. The non-hematological toxicity was often mild to middle,and feasible acceptability.A sufficient number of stem cells could be harvested in all patients by bone marrow harvest or/and PBSCs mobilization.All patients reconstituted hematopoiesis after ASCT only except one patient died of very early toxic after conditioning regimen.After a median of 80.5months follow up from CRl,the total TRM was 10.14 %. The probabilities of 5 year OS for AML and ALL was （55.36±3.69）% and （56.90±3.56）%, respectively,and the LFS （55.51±3.70）% and （58.09±3.14）%. Conclusion The above results indicated that ASCT performed after I/ HIDAC based intensive chemotherapy for a adult patients with acute leukemia in CR1 could produced a relative high long-term OS and LFS. The patients were well tolerated.