HLA半相合造血干细胞移植治疗首次复发的急性髓系白血病

Haploidentical hematopoietic stem-cell transplantation for acute myeloid leukemia in first relapse after complete remission by standard induction chemotherapy

目的探讨遗传上HLA半相合外周血造血干细胞移植（Haplo—PBSCT）对首次复发后的成人急性髓系白血病（AML）的治疗效果。方法89例成人AML患者接受常规柔红霉素一高剂量阿糖胞苷（DA／Hi—Ara-C）化疗缓解后出现首次复发，其中复发后接受Haplo-PBSCT治疗者53例，平均年龄38．6岁（18～51岁），复发时间为首次缓解后7．7个月（1～24个月）；接受去甲氧柔红霉素-中剂量阿糖胞苷（iDA／Mid—Ara-C）或米托蒽醌-中剂量阿糖胞苷（MA／Mid—Ara-C）方案继续化疗者26例，平均年龄47．6岁（18～61岁），复发时间为首次缓解后8．9个月（1～30个月）。结果接受Haplo—PBSCT治疗者和接受化疗者再次完全缓解率（CR）分别为86．7％（46／53）和38．1％（9／23），两者比较，差异有统计学意义（P〈0．01）。接受Haplo-PBSCT治疗者和接受化疗者36个月的疾病进展后存活（SPP）率分别为43．4％（23／53）和11．5％（3／26），两者比较，差异有统计学意义（P〈0．05）。结论相对于接受iDA／Mid-Ara-C或MA／Mid-Ara-C方案继续化疗者，Haplo—PBSCT能明显提高首次复发后AML患者的再次缓解率以及延长SPP时间。

Objective To investigate the therapeutic effects of haploidentical hematopoietic stem-cell transplantation （Haplo-PBSCT） for acute myeloid leukemia in first relapse after complete remission by standard induction chemotherapy. Methods Eighty-nine cases of AML in first relapse after complete remission by standard DA/Hi-Ara-C regimens induction chemotherapy were evaluated retrospectively. Fiftythree cases were grafted by haplo-PBSCT and 26 cases were treated with iDA/Mid-Ara-C or MA/Mid-Ara- C agents. Results The second remission rate in haplo-PBSCT group and continuous chemotherapy group was 86. 7 % （46/53 cases） and 38. 1 % （9/23 cases） respectively （P〈0. 01）. Survival postprogression （SPP） at 36th month was 43. 4 % （23/53 cases） in haplo-PBSCT group and 11.5 % （3/26 cases） in continuous chemotherapy group （P 〈 0. 05 ）. Conclusion Haplo-PBSCT could significantly increase the second remission rate and prolong the survival time of patients with acute myeloid leukemia in first relapse after complete remission by standard induction chemotherapy.