自体造血干细胞移植治疗急性淋巴细胞白血病30例疗效分析

Treatment of acute lymphoblastic leukemia by autologous stem cell transplantation:an analysis of 30 cases

目的 评价自体造血干细胞移植 (ASCT)治疗急性淋巴细胞白血病 (ALL)的疗效及部分影响因素。方法 ASCT治疗ALL患者 3 0例 ,其中第 1次完全缓解 (CR1) 2 4例 ,第 2次完全缓解 (CR2 )或早期复发 6例。预处理方案包括环磷酰胺 (CTX) 1 2 0mg/kg +单次全身照射 (sTBI) 9～ 1 0Gy或 +马利兰 (Bu) 1 6mg/kg或 +马法兰 (Mel) 1 40～ 1 80mg/m2 +阿糖胞苷 (Ara C) 2～ 4g/m2 等。结果 患者移植后均重建造血 ,中位随访时间 50 4 (1 8～ 3 0 4 3 )d ,移植相关死亡 3例 (1 0 .0 % ) ,CR1及CR2 或早期复发期移植者 3年无病生存率分别为 (67.7± 1 0 .3 ) %和 (1 6.7± 1 5.2 ) % (P =0 .0 0 547) ,CR1期移植后有治疗和无治疗者 3年无病生存率分别为 (92 .3± 7.4 ) %和 (50 .0± 1 7.7) % (P =0 .0 1 3 0 )。结论 急性淋巴细胞白血病CR1期ASCT疗效明显高于常规化疗 ,但CR2 以上者移植后复发率很高 ,因此无HLA相匹配供者的患者尽可能在CR1期进行ASCT治疗 ,以获得较好的疗效。另外采用移植后治疗可减少复发率 ,提高疗效。

Objective To evaluate the clinical outome of autologous stem cell transplantation (ASCT) in acute lymphoblastic leukemia (ALL) and the affected factors. Methods Data of 30 ALL patients received ASCT in our hospital between July 1987 and December 1997 were retrospectively analyzed. Twenty four of them were in the first complete remission (CR 1) and six in the second complete remission (CR 2) or early relapse (ER). Conditioning regimens were CTX 120?mg/kg+ single total body irradiation 9～10?Gy (sTBI) or Bu 16mg/kg of Mel 140～180?mg/m 2+Ara c 2～4?g/m 2. Results All patients reconstituted hematopoiesis. The median follow up duration was 504 (18 3043) days. Transplant related mortality was 10%. The probabilities of 3 year disease free survival (DFS) for ALL in CR 1 and CR 2 were 67.7%±10.3% and 16.7%±15.2%,respectively (P=0.00547); the 3 year DFS was significantly better with posttransplant treatment than without it (92.3%±7.4% vs 50.0%±17.7%,P=0.0130). Conclusion Acute lymphoblastic leukemia patients without HLA matched related donor are recommended for ASCT in CR 1. To reduce relapse and improve the outcome, adoptive immunotherapy or maintenance chemotherapy should be given after ASCT.