异体淋巴细胞输注防治白血病移植后复发的疗效及安全性分析

Efficacy and Safety of Allogenic Lymphocyte Transfusion for the Prevention and Treatment of Relapsed Leukemia after Hematopoietic Stem Cell Transplantation

目的:探讨异体淋巴细胞输注防治白血病造血干细胞移植(HSCT)后复发的疗效及安全性。方法:回顾性研究2000年2月至2010年4月间在南方医科大学珠江医院行HSCT后进行异体淋巴细胞输注的35例白血病患者,包括20例自体造血干细胞移植(Auto-HSCT)患者和15例异基因造血干细胞移植(Allo-HSCT)患者。结果:35例患者3年总生存(OS)率为43.3%,3年无病生存(DFS)率为38.9%。Auto-HSCT患者行异体淋巴细胞输注患者的3年OS为63.2%,3年DFS为55.0%。而Allo-HSCT患者复发后行治疗性输注的患者完全缓解率(CR)仅为35.7%,3年OS为10.0%。患者死亡原因主要是疾病复发(17例)、骨髓抑制(1例)及急性GVHD(1例)等。结论:异体淋巴细胞输注是防治移植后复发的有效方法,高复发风险的患者行预防性输注有望提高生存期,且异体淋巴细胞输注相关副作用无明显增加。

Objective： This study aims to investigate the efficacy and safety of allogenic lymphocyte transfusion （ALT） for the prevention and treatment of relapsed leukemia after hematopoietic stem cell transplantation （HSCT）. Methods： Data of 35 consecutive leukemia patients receiving ALT in our hospital from 2000 to 2010 were retrospectively studied, among which 20 were receiving auto-HSCT and 15 were receiving allo-HSCT. Results： The three-year overall survival （OS） and disease-free survival （DFS） were 43.3% and 38.9%, respectively in all patients. In the auto-HSCT patients mainly undergoing preventative ALT, the three-year OS and DFS were 66.8% and 62.3%, respectively, whereas the complete remission and three-year OS for the allo-HSCT patients mainly receiving allo-HSCT were only 35.7% and 10.0%, respectively. The main cause of death in these patients included relapse of the disease （n=17）, bone marrow inhibition _（n=1）, and acute graft-versus-host disease （n=1）. Conclusion： ALT is an effective therapy for the prevention and treatment of relapsed leukemia. Preventative allo-HSCT may significantly improve the survival time for high-risk patients, without overt increase of treat ment-related mortality.