成人急性淋巴细胞白血病自体移植与异基因移植

Autologous versus Allogeneic Stem Cell Transplantation in Adult Patients with Acute Lymphoblastic Leukemia

目的 分析成人急性淋巴细胞白血病（ALL）自体移植与异基因移植的疗效，并探讨相关临床预后因素。方法 对1986年11月-2004年6月移植治疗的96例成人ALL患者随访至2005年2月28日，按治疗方式分为自体移植组（56例）和异基因移植组（40例），其中自体移植组进一步分为移植物体外净化和移植后维持治疗组（处理组，26例）和未处理组（30例）；对各组患者的临床特征及治疗转归进行回顾性研究，应用Kaplan-Meier法进行生存分析，COX回归模型进行多因素预后分析。结果 自体移植组总体与异基因移植组比较，两组1、3、5年预期无白血病生存率（LFS）差异无显著性；自体移植处理组、自体移植未处理组与异基因移植组3组比较，3、5年LFS差异具有显著性（P〈0．05），分别为：[（73．0±8．7）％、（69．2±9．0）％]，[（42．2±10．1）％、（35．1±10．0）％]和[（50．9±8．2）％、（50．9±8．2）％]。结论 自体移植组（总体）与异基因移植组长期LFS相近；自体移植组给予移植物体外净化和移植后维持治疗可显著降低复发率，改善患者长生存。

Objective To explore the efficacy of autologous or allogeneic stem cell transplantation in adult patients with acute lymphoblastic leukemia （ALL） and investigate its relevant prognostic factors. Methods A total of 96 adult patients with ALL who had admitted to our hospital from November 1986 to June 2004 were followed up till February 28, 2005. They were divided into autologous stem cell transplantation （ Auto- SCT） group （ n = 56） and allogeneic stem cell transplantation （Allo-SCT） group （ n = 40）. Auto-SCT group was further divided to treated subgroup, in which patients received graft-purified transplantation and （or） maintenance immunotherapy or chemotherapy after transplantation （n = 26）, and non-treated subgroup （ n = 30）. Clinical characteristics of these groups were retrospectively analyzed. Survival date were analyzed by the Kaplan-Meier method and the prognostic factors were analyzed with the COX regression model. Results The 1-, 3-, and 5-year leukemia-free-survival （LFS） were not significantly different between the auto-SCT group and the allo-SCT group. The 3-and 5-year LFS of auto-SCT treated subgroup, auto-SCT non-treated subgroup and allo-SCT group were [（73.0±8.7）%, （69.2±9.0）%], [（42.22±10.1）%, （35.1±10.0）%], and [ （ 50.9 ± 8.2） %, （50. 9± 8.2 ） % ], respectively, which showed statistical significance （ P 〈 0.05 ）. Conclusions The long-term LFS is similar after auto-SCT and after allo-SCT. Purified graft and maintain immunotherapy or chemotherapy post-transplantation may decrease the relapse rate after auto-SCT and improve survival.