自体造血干细胞移植治疗急性淋巴细胞白血病43例:远期疗效分析

Autologous hematopoietic stem cell transplantation for treatment of 43 patients with acute lymphocytic leukemia: An analysis of the long-term curative effect

目的:异基因造血干细胞移植治疗急性淋巴细胞白血病的疗效已不容置疑,在不具备异基因造血干细胞移植条件下,评价自体造血干细胞移植治疗急性淋巴细胞白血病的疗效。方法:选取1989-05/2000-07解放军总医院血液科43例急性淋巴细胞白血病患者,所有患者均同意行自体造血干细胞移植。中位年龄24.5(11～48)岁。单次移植29例,其中移植前首次完全缓解期23例,二次缓解期5例,未缓解期1例。双次移植14例,其中首次移植和第二次移植前为二次缓解期各1例,其余移植前均为首次完全缓解期。预处理方案:包括含全身放疗(26例)、全淋巴放疗(14例)与不含全身放疗的高剂量化疗方案(3例)。移植后治疗:化疗长春新碱+泼尼松/6-巯基嘌呤+甲氨蝶呤方案和白细胞介素2免疫维持治疗。结果:单次自体造血干细胞移植29例5年无病存活10例,其中移植前首次完全缓解期9例,二次缓解期1例。5年无病存活率34.5%。双次移植14例5年无病存活6例,5年无病存活率为42.9%。两次移植前均为首次完全缓解期。结论:在不具备异基因造血干细胞移植条件下,可采用自体造血干细胞移植治疗急性淋巴细胞白血病,双次自体造血干细胞移植疗效较好。

AIM： AIIogeneic hematopoietic stem cell transplantation （alIo-HSCT） for acute lymphocytic leukemia （ALL） can achieve better curative effect. The curative effect of autologous hematopoietic stem cell transplantation （AHSCT） on the treatment of ALL was evaluated when alIo-HSCT cannot be performed. METHODS： Totally 43 patients with ALL were included at Department of Hematology, General Hospital of Chinese PLA from May 1989 to July 2000 and they agreed to receive AHSCT. Median age was 24.5 （11-48） years. Twenty-nine patients received Single-AHSCT, including 23 cases in first complete remission （CR1）, 5 cases in second complete remission （CR2） and 1 case in non-complete remission （NCR） before transplantation. Fourteen patients received Double-AHSCT, including 1 case in CR2 before the first transplantation, 1 case in CR2 before the second transplantation, others all in CR1 before transplantation. Conditioning regimens were composed of high dose chemotherapy with total body irradiation （TBI） （26 cases）, total lymphoid irradiation （TLI） （14 cases） or without TBI （3 cases）. Treatment after transplantation was composed of vincristine-prednisone （VP）, 6-mercaptopurine-methotrexate （MM） chemotherapy and interleukin （IL）-2 immunotherapy maintenance regimens. RESULTS： Ten cases were disease-free survival in 29 Single-AHSCT patients, including 9 cases in CR1 and 1 case in CR2. The disease-free survival （DFS） was 34.5% in 5 years. Six cases all in CR1 before two transplantations were disease-free survival in 14 Double-AHSCT patients. The DFS was 42.9% in 5 years. CONCLUSION： AHSCT can be received to treat ALL when alIo-HSCT cannot be performed. Double-AHSCT can achieve better curative effect.