非血缘脐血移植治疗急性髓系白血病58例疗效分析

Efficacy analysis of unrelated cord blood transplantation for 58 acute myelogenous leukemia patients

目的探讨非血缘脐血移植（UCBT）治疗急性髓系白血病（AML）的疗效及影响疗效的相关因素。方法回顾性分析接受UCBT治疗58例AML患者的临床资料。中位年龄14．5（3～36）岁，中位体重45（12～90）kg。FAB分型：M0 1例、M1 1例、M2 35例（包括骨髓增生异常综合征转AML 1例）、M4 3例、M5 14例、M6 3例、混合细胞白血病1例。移植时处于第1次完全缓解期（CR1）36例，第2次完全缓解期（CR2）14例，未缓解（NR）8例，其中高危难治患者43例（74．1％）。单份UCBT 49例（84．5％），双份UCBT 9例（15．5％）。所有患者均采用强化清髓预处理方案，采用环孢素联合霉酚酸酯预防移植物抗宿主病（GVHD）。结果全部58例患者中56例（96．6％）获得造血重建，中性粒细胞植入、血小板植入的中位时间分别为17（12～37）d、33（17～140）d。24例（42．9％）患者发生急性GVHD，其中Ⅱ～Ⅳ度急性GVHD的发生率为30．4％（17／56）。在可评估的49例患者中，7例（14．3％）出现慢性GVHD（均为局限型）。预期3年累积总体生存（OS）率和无病生存（DFS）率分别为（60．3±6．4）％和（60．1±6．5）％。3年非复发死亡率为33．3％，复发率为9．1％。UCBT时疾病为CR患者（50例）的3年OS率高于NR患者（8例）[（66．0±6．7）％对（25．0±15．3）％，P=0．013]。结论UCBT治疗AML安全有效，慢性GVHD发生率和复发率较低。

Objective To evaluate the therapeutic efficacy and related risk factors of acute myelogenous leukemia （AML） patients treated with unrelated cord blood transplantation （UCBT）. Methods A retrospective analysis was performed on the clinical data of 58 AML patients that consisted of 1 case of M0, 1 case M1, 35 cases M2, 3 cases M4, 14 cases Ms, 3 cases M6, and 1 case acute mixed leukemia, respectively. Of them, 1 case AML secondary to myelodysplastic syndrome, and 36 in first complete remission （CR,）, 14 in second complele remission （CR2）, 8 in non-remission （NR）, 43 cases were refractory or high-risk patients （70.1%）. The median age was 14.5 years with the median weight of 45 kg, 49 patients received sUCBT and 9 dUCBT. All the patients conditioned with intensified myeloablative regimen and received a combination of Cyclosporine A （CsA） and mycophenolate mofetil （MMF） to prevent graft-versus-host disease （GVHD）. Results 56 out of 58 patients achieved engraftment with implantation rate 96.6%. The median time of ANC≥0.5 × 10^9/L was 17 （12-37） days, and that of PLT≥20 × 10^9/L 33 （17-140） days respectively. 24 cases developed acute GVHD （aGVHD）, the incidence rate of grade Ⅱ to Ⅳ aGVHD was 30.4%. The chronic GVHD （cGVHD） was occured in 7 patients of the 49 evaluable patients, all were limited. The estimated 3-year overall survival （OS） and disease-free survival （DFS） were （60.3±6.4）% and （60.1±6.5）% respectively. And the cumulative incidences of 3-year nonrelapse mortality （NRM） and relapse were 33.3% and 9.1% respectively. The 3-year OS rates of AML patients were （66.0±6.7）% for CR and （25.0± 15.3）% for NR, differences were statistical significance.Conclusions For AML patients, UCBT was conducive to improve outcome with lower inciclences ol cGVHD and relapse, the patients after transplantation could obtain high quality of life.