慢性移植物抗宿主病对急性髓系白血病患者复发及生存的影响

Effect of chronic graft versus host disease on relapse and survival in patients with acute myeloid leukemia

目的 探讨慢性移植物抗宿主病（cGVHD）对造血干细胞移植（HSCT）后急性髓系白血病（AML）患者复发及生存的影响.方法 回顾性分析接受异基因外周血HSCT的55例发生cGVHD及未发生cGVHD的AML患者复发及生存情况.结果 cGVHD组移植后2年内的AML复发率显著低于未发生cGVHD组（8.7％对38.6％,P=0.019）,而2年后远期复发率与对照组比较差异无统计学意义（22.8％对5.9％,P=0.217）;移植后2年内的生存率差异无统计学意义（78.3％、61.0％,P=0.155）,远期生存率cGVHD组明显降低（63.7％对100％,P=0.011）.在难治复发的高危AML患者中,cGVHD组与未发生cGVHD组比较,移植后2年内AML复发率低（8.3％对46.2％,P=0.044）,生存率高（83.3％对47.2％,P=0.045）;在中低危AML患者中,有或无cGVHD其复发率及生存率均无显著变化（P=0.266,P=0.289）.局限型及广泛型cGVHD患者中,移植后复发率分别为27.3％和31.3％,较未发生cGVHD患者复发率（42.2％）均下降;但广泛型cGVHD患者远期生存率降低（53.3％,P=0.001）.结论 cGVHD降低AML复发的保护作用主要发生在移植后早期（2年）,尤其使得难治复发的高危AML患者受益;而在移植晚期,cGVHD尤其广泛型cGVHD与移植相关死亡率相关,明显降低远期生存率.

Objective To explore the influence of relapse and survival by chronic graft versus host disease （cGVHD） in patients with acute myeloid leukemia （AML） after allogeneic hematopoietics stem cell transplantation （allo-HSCT）.Methods Fifty-five AML patients received allo-HSCT were retrospectively reviewed.Relapse rate and overall survival （OS） were analyzed according to cGVHD.Results cGVHD significantly decreased the relapse rate of AML patients after transplantation within 2 years when compared with those without cGVHD （8.7% vs 38.6%,P=0.019）,however,cGVHD had no effect on the long-term relapse rate （22.8% vs 5.9%,P=0.217）.cGVHD had no effect on OS within 2 years （78.3% vs 61.0%,P=0.155） but could decrease the rate of long-term survival （63.7% vs 100%,P=0.01）.cGVHD also could reduce the rate of relapse （8.3% vs 46.2%,P=0.044） and enhanced the rate of survival （83.3% vs 47.2%,P=0.045） in patients with high risk AML after allo-HSCT in 2 years,while it had no effect on the relapse rate and OS in patients with low and intermediated risk AML in early and late phase.Moreover,compared with the rate of relapse （38.6%） in patients without cGVHD,the rate of relapse were lower in patients with limited cGVHD and intensive cGVHD （27.3% and 31.3%,respectively） but the long-term survival was significantly lower （53.3%,P=0.001） in those patients with intensive cGVHD after all-HSCT.Conclusion The benefit effect of cGVHD mainly took place within 2 years after allo-HSCT in AML patients especially in those with high risk,while in late phase after allo-HSCT,cGVHD especially intensive cGVHD had an effect on reducing long-term survival.