成人急性淋巴细胞白血病自体造血干细胞移植联合化疗的临床研究

Autologous stem cell transplantation for adult patients with acutelymphoblastic leukemia and related prognostic factors

目的观察成人急性淋巴细胞白血病（ALL）患者行自体造血干细胞移植（auto—HSCT）的疗效，并探讨相关的预后危险因素。方法对2001年11月至2012年1月行auto—HSCT的86例成人ALL患者进行随访，并对所有患者的临床特征及治疗转归进行回顾性分析，应用Kaplan—Meier法进行生存分析，用COX回归模型评估独立预后因素。结果可评价疗效的81例auto—HSCT患者中标危47例，高危34例。标危组患者1、3、5、10年无病生存（LFS）率分别为（82．3±5．7）％、（76．9±6．5）％、（74．1±6．8）％、（67．4±8．9）％；累积复发（RR）率分别为（13．6±5．2）％、（21．6±6．4）％、（24．5±6．8）％、（31．3±9．0）％。高危组患者1、3、5、10年LFS率分别为（55．8±8．9）％、（39．8±9．3）％、（39．8±9．3）％、（39．8±9．3）％；RR率分另0为（38．8±9．2）％、（56．4±10．0）％、（56．4±10．0）％、（56．4±10．0）％。而疾病类型为T—ALL、初诊时WBCI〉30×10^9／L、乳酸脱氢酶增高、TCR重排阳性及移植物来源于骨髓均为影响预后的不良因素，进一步应用COX多因素回归模型进行预后因素分析显示，移植物来源于骨髓是独立的预后不良因素。结论成人ALL患者如果没有合适的供者，auto—HSCT也是治疗的一种有效手段。

Objective This study was aimed to observe the efficacy of autologous stem cell transplan- tation （ASCT） for adult patients with acute lymphoblastic leukemia （ ALL）, and investigate related prognostic factors. Methods A total of 86 adult ALL patients underwent ASCT in Institute of Hematology and Blood Disease Hospital from November 2001 to January 2012 were followed up. Clinical characteristics and outcomes of all patients were retrospectively analyzed. Survival and univariate prognosis were analyzed by the Kaplan- Meier method and multivariate analysis by COX regression model. Results Outcomes were assessed in 81 cases, including 47 standard-risk and 34 high-risk patients. 1-, 3-, 5-, and 10-year leukemia-free survival （LFS） of standard-risk patients were （82.3 ± 5.7）%, （76.9 ± 6.5）%, （74.1 ±6.8）%, （67.4 ± 8.9）% respectively,and relapse rates （RR） were as of （ 13.6 ± 5.2）%, （21.6±6.4）%, （24.5± 6.8）% ,（31.3 ±9.0）% respectively. 1-, 3-, 5-, and 10-year LFS of high-risk patients were （55.8± 8.9） %, （39.8 ± 9.3 ） %, （ 39.8 ± 9.3 ） %, （39.8 ± 9.3 ） % respectively, and relapse rates （RR） were （38.8 ±9.2）%, （56.4 ± 10.0）%, （56.4 ± 10.0）%, （56.4 ± 10.0）% respectively. T-ALL, white blood cell count（WBC） more than 30 × 10^9/L when first visited, increased LDH, positive fusion gene of TCR and bone marrow transplantation were the adverse prognostic factors. Multivariate analysis showed bone marrow transplantation was an independent adverse prognostic factor. Conclusion ASCT was a choice for adult ALL patients when suitable donors were unavailable.