自体造血干细胞移植治疗急性髓系白血病77例

Autologous hematopoietic stem cell transplantation for treatment of 77 patients with acute myelogenous leukemia

背景:急性髓系白血病采用化疗方案效果欠佳,而异基因造血干细胞移植虽然是最有效的治疗方法,但寻找到HLA相合的供者概率较低,且易发生严重并发症。目的:评价自体造血干细胞移植对急性髓系白血病的改善效果。设计、时间及地点:回顾性病例分析,于1989-01/2007-03在解放军总医院血液科完成。对象:选取急性髓系白血病患者77例,中位年龄27.6岁,均同意行自体造血干细胞移植,实验经医院医学伦理委员会批准。单次造血干细胞移植72例,其中自体外周血造血干细胞移植21例、自体骨髓移植51例;移植前CR1期69例,CR2期2例,CR3期1例。双次造血干细胞移植5例,其中均为自体骨髓移植1例,其余4例分别为首次进行骨髓移植和第2次进行自体外周血造血干细胞移植,移植前均为CR1期。方法:骨髓移植患者按单个核细胞(0.8～1.5)×108/kg采集骨髓细胞,外周血干细胞移植患者在联合化疗后行粒系-巨噬集落刺激因子动员,当白细胞>5.0×109L-1时采集造血干细胞。骨髓移植及外周血干细胞移植患者回输单个核细胞中位数分别为2.62×108/kg,4.03×108/kg。25例患者行TLI预处理方案,47例患者行TBI预处理方案,5例患者行不含TBI的高剂量化疗预处理方案。9例患者给予移植后治疗,接受VP/MM维持化疗3例,接受白细胞介素2+干扰素α免疫维持治疗4例,三者联合维持化疗2例。移植后每3个月进行随访,定期检测血常规、骨髓象等变化。主要观察指标:移植后造血重建情况、存活情况以及维持治疗对患者骨髓功能的影响。结果:所有患者均获得髓系造血重建。72例单次自体造血干细胞移植患者无病存活42例,其中移植前CR1期41例,CR3期1例,至今无病存活率58.3%;5例双次自体造血干细胞移植患者至今无病存活4例。定期进行血象和骨髓象复查,均未发现移植后维持治疗对患者骨髓功能有明显影响,患者对维持治疗的耐受性良好。结论:自体造血干细胞移植治疗急性髓系白血病安全有效,可改善难治急性髓系白血病患者预后。

AIM： Acute myelogenous leukemia （AML） patients treated by standard chemotherapy seldom had a good efficacy. Allogeneic hematopoietic stem cell transplantation is the best way to treat AML patients, but it was difficult to find HLA-matched donor and easy to generate severe complications. OBJECTIVE： To evaluate effect of autologous hematopoietic stem cell transplantation on the treatment of acute AML. DESIGN, TIME AND SETTING： The retrospective case analysis was performed at the Department of Hematology, General Hospital of Chinese PLA from January 1989 to March 2007. PARTICIPANTS： A total of 77 AML patients were included. Median age was 27.6 years. They all agreed to receive allogeneic hematopoietic stem cell transplantation. The experiment was approved by Hospital＇s Medical Ethics Committee. Seventy-two patients received single-allogeneic hematopoietic stem cell transplantation, including twenty-one cases undergoing allogeneic peripheral blood hematopoietic stem cell transplantation and fifty-one cases undergoing allogeneic bone marrow hematopoietic stem cell transplantation. There were 69 cases in CR1, 2 cases in CR2, and 1 case in CR3 before transplantation. Five patients received double-allogeneic hematopoietic stem cell transplantation, and all were in CR1. One case was treated with allogeneic bone marrow hematopoietic stem cell transplantation. Remaining four cases were firstly treated with bone marrow transplantation, and secondly with peripheral blood transplantation. METHODS： Bone marrow cells were collected according to （0.8-1.5 ）×10^8/kg. Following chemotherapy, granulocyte-macrophage colony stimulating factor was mobilized in peripheral stem cell transplantation patients. Hematopoietic stem cells were collected when white blood cells 〉 5.0×10^9 L^-1. Medians of mononuclear cells for reinfusion were respectively 2.62×10^8/kg and 4.03× 10^8/kg in bone marrow and peripheral blood stem cell transplantation patients. Twenty-five patients received total lymphoid irradiation （TLI） preconditioning, and forty-seven patients received total body irradiation （TBI） preconditioning. Five cases received high-dose chemotherapy without TBI. Following transplantation, three cases received VP/MM maintenance chemotherapy, four cases received interleukin 2 ＋ interferon α therapy, and two cases received VP/MM maintenance chemotherapy, interleukin 2 ＋ interferon α therapy. Follow-up was performed every three months. Blood routine and myelogram were regularly examined. MAIN OUTCOME MEASURES： Effects of hematopoietic reconstruction, survival and maintenance therapy on bone marrow functions of patients following transplantation. RESULTS： All patients underwent hematopoietic reconstruction. A total of 42 cases were disease-free survival in 72 single-allogeneic hematopoietic stem cell transplantation patients, including 41 cases in CR1, 1 case in CR3. The disease-free survival rate up to now was 58.3%. A total of 4 cases were disease-free survival up to now in 5 patients with double-allogeneic hematopoietic stem cell transplantation. Blood routine and myelogram were regularly examined, and no effect of maintenance therapy on bone marrow functions of patients was presented. There was good tolerance of patients on maintenance therapy. CONCLUSION： Allogeneic hematopoietic stem cell transplantation is a safety and effective option that can significantly improve the prognosis of AML.