单倍体相合造血干细胞移植后重建的淋巴细胞数量对受者预后的预测

Rapid early recovery of absolute lymphocyte counts at day 30 can predict reduced risk of relapse in acute lymphoblastic leukemia following hapioidentcial allogeneic stem cell transplantation

目的探讨急性淋巴细胞白血病（ALL）患者接受非体外去除T淋巴细胞的单倍体相合骨髓和外周血造血干细胞移植（HBMT）后30d重建的淋巴细胞绝对数量（ALC-30）对移植预后的预测。方法回顾性分析2003年1月至2007年9月因ALL接受HBMT的62例受者的临床资料，根据受者的ALC-30水平，将受者分为ALC-30≥300／μl组（高ALC-30组）和ALC-30〈300／μl组（低ALC-30组）。观察两组受者移植后ALL复发、移植相关死亡、总体存活率（OS）和无复发存活率（LFS）。结果单因素及多因素分析结果均显示，与低ALC-30组相比，高ALC-30组受者具有较低的移植相关死亡率[（10.5±5．7）％和（30．8±8．1）％，（P=0．046）]和ALL复发率[（14．7±6．8）％和（59．1±10．3）％，（P=0．002）]及较高的OS[（79．3±7．5）％和（45．1±8．7）％，（P=0．006）]和LFS[（79．3±7．5）％和（28．4±8．0）％，（P〈0．001）]。结论ALL患者接受HBMT后30d淋巴细胞快速重建可以预测良好的移植预后。

Objective To explore the impact of early recovery of absolute lymphocyte counts at day 30 post transplantation on transplant outcome in patients with acute lymphoblastic leukemia（ALL） following unmanipulated haploidentical allogeneic blood and marrow transplantation （HBMT）. Method A total of 62 patients with acute lymphoblastic leukemia receiving unmanipulated HBMT between Jan. 2003 and Sep. 2009 at Peking University Institute of Hematology were evaluated for the occurrence of early recovery of absolute lymphocyte counts at day 3（1 （ALC-30）. Patients were subgrouped into ALC-30≥300/μl group （n = 29） and ALC-30 〈300/pd group （n = 33） based on the cutoff value of lymphocyte count at day 30 following transplantation to explore the effect of ALC-30 on transplant outcomes, including ALL relapse, transplantation related mortality （TRM）, overall survival rate（OS）, and ALL leukemia free survival rate （LFS）. Result Univariate and multivariate analysis showed that compared to those in ALC-30≥300/μl group, patients in ALG30≥300/μl group had lower TRM rate （10. 5%±5.7% vs. 30. 8% ± 8. 1%, P= 0. 046） and ALL relapse rate （14. 7%±6.8% vs. 59.1%±10.3%, P =0.002）, therefore had higher OS （79. 3% ± 7. 5% vs. 45.1%±8.7%, P=0.006） and LFS （79.3%±7.5% vs. 28.4% ±8.0%, P〈0.001）.Conclusion Early recovery of ALC-30 can predict clinical outcomes in ALL patients following unmanipulated HBMT.