成人急性淋巴细胞白血病自体和异基因造血干细胞移植疗效对比分析

Comparison of outcomes of adult acute lymphoblastic leukemia patients underwent autologous and allogeneic hematopoietic stem cell transplantation

目的 对比分析成人急性淋巴细胞白血病（ALL）自体造血干细胞移植（auto-HSCT）和异基因造血干细胞移植（allo-HSCT）疗效差异.方法 研究纳入2007年1月至2010年12月进行造血干细胞移植（HSCT）的106例成人ALL患者,其中auto-HSCT 50例,首次完全缓解（CR1）46例,第2次CR（CR2）4例,高危组21例,移植前检测微小残留病（MRD）均阴性;allo-HSCT患者56例,CR151例,CR25例,高危组44例,移植前14例MRD阳性.结果 106例患者移植后中位随访22.9（0.8～63.3）个月,29例血液学复发.其中auto-HSCT、allo-HSCT患者3年累积复发率（RR）分别为（29.9±8.0）％和（32.7±6.8）％（P=0.402）.标危组患者auto-HSCT和allo-HSCT后RR差异无统计学意义（P=0.554）,高危组患者auto-HSCT和allo-HSCT后RR差异亦无统计学意义（P =0.967）.allo-HSCT患者2年累积非复发死亡率（NRM）[（22.3±6.0）％]显著高于auto-HSCT患者（0）（P=0.001）.标危组患者auto-HSCT和allo-HSCT后3年总生存（OS）率分别为（77.1±13.2）％和（90.9±8.7）％ （P=0.739）.高危组患者auto-HSCT和allo-HSCT后3年OS率分别为（68.7±10.8）％和（45.2±8.5）％（P=0.094）.结论 成人ALL患者auto-HSCT和allo-HSCT同样有效,如果患者MRD持续阴性,auto-HSCT可成为allo-HSCT的有效替代治疗手段.

Objectve To compare the outcomes of adult patients with acute lymphoblastic leukemia （ALL） who underwent autologous hematopoietic stem cell transplantation （auto-HSCT） and allogeneic hematopoietic stem cell transplantation （allo-HSCT）.Methods From Jan 2007 to Dec 2010,106 adult ALL patients were retrospectively divided into two groups,50 in auto-HSCT group and 56 in allo-HSCT group.Auto-HSCT group included 21 patients with high-risk,46 patients in CR1 and 4 cases in CR2.All the 50 patients had negative minimal residual disease （MRD） prior to HSCT.Allo-HSCT group included 44 patients with high risk,5 l patients in CR1 and 5 cases in CR2,15 patients with positive MRD before allo-HSCT.Results Of the total 106 patients,29 patients relapsed at a medium follow-up of 22.9 （0.8-63.3） months.The 3-year cumulative relapse rate （RR） was （29.9±8.0） % in auto-HSCT group and （32.7±6.8） % in allo-HSCT group.There were no significant differences in RR and overall survival （OS） between auto-HSCT and allo-HSCT groups,even of stratified risk groups.In standard risk group,3-year OS was （77.1±13.2） % in auto-HSCT group and （90.9±8.7） % in allo-HSCT group （P=0.739）.In high-risk group,3-year OS was （68.7±10.8） % after auto-HSCT and （45.2±8.5） % after allo-HSCT （P=0.094）.Conclusion Due to acceptable RR and OS,adult ALL patients with no MRD before HSCT showed favorable survival.Auto-HSCT may be a considerable choice for adult ALL patients with negative MRD when lacking of donors for allo-HSCT.