异基因造血干细胞移植治疗急性白血病28例临床分析

Analysis of allogenetic hematopoietic stem cell transplantation for the treatment of 28 patients with acute leukemia

目的评价异基因造血干细胞移植(allo-HSCT)治疗急性白血病的疗效。方法收集2005年1月～2011年8月本院行allo-HSCT的急性白血病28例,其中,急性淋巴细胞白血病7例,急性髓系白血病21例。26例为同胞全相合,2例同胞5/6相合。预处理方案22例为马利兰/环磷酰胺,3例为改良马利兰/环磷酰胺,3例为马利兰/环磷酰胺/氟达拉滨。常规采用环孢素联合短程甲氨喋呤预防移植物抗宿主病。结果所有患者移植后造血功能均快速重建。中位随访时间22个月,至随访结束,总生存率71.4%,其中,16例患者(57.1%)已无病生存11～79个月。未出现急性移植物抗宿主病,6例发生慢性移植物抗宿主病(cGVHD),8例于移植后死于cGVHD、感染或疾病复发。移植前首次化疗即达完全缓解者(即CR1)移植后总生存率及无病生存率均比CR2或NR患者同期增高。结论异基因造血干细胞移植是急性白血病安全有效的治疗方法,CR1后应尽早选择异基因造血干细胞移植。

Objective To evaluate the clinical curative effect of allogeneic hematopoietic stem cell transplantation(allo-HSCT) for acute leukemia(AL).Methods Twenty-eight patients with AL,including 7 cases with acute lymphoblastic leukemia(ALL),and 21 cases with acute myeloid leukemia(AML),received the treatment of allo-HSCT with HLA matched sibling donors except 2 cases(5/6 matched) in our hospital from January 2005 to August 2011.Twenty-two patients were pre-conditioned with busulfan(Bu) and cyclophosphamide(Cy) regimen,3 patients with modified Bu/Cy regimen,3 patients with fludarabine(F)/Bu/Cy regimen.The routine prevention of graft versus host disease(GVHD) consisted of methotrexate(MTX) and cyclosporine A(CsA).Results All patients were quickly achieved hematopoietic reconstitution after allo-HSCT.The median follow-up duration was 22 months.At the end of follow-up,overall survival(OS) was 71.4%,among them,16 patients(57.1%) survived with disease-free survival(DFS) in 11 to79 months after allo-HSCT.There was no GVHD presented,6 patients had chronic GVHD.Eight patients were respectively died of cGVHD,relapse or progression of infection and disease after transplantation.The patients who had complete remission after the first chemotherapy(CR1) achieved higher overall survival rate and disease-free survival rate after transplantation than those who had complete remission after the second chemotherapy(CR2) or none remission(NR) patients during the same period.Conclusion Allo-HSCT is an effective method for treatment of AL,and the patients should adopt allo-HSCT as soon as possible after the CR1.