异基因造血干细胞移植治疗急性淋巴细胞白血病的近期疗效及远期预后分析

Short-term effects and long-term prognosis of allogeneic hematopoietic stem cell transplantation in treating acute lymphoblastic leukemia

目的探讨异基因造血干细胞移植治疗急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)的近期疗效及远期预后分析。方法选取2008年9月—2011年12月白求恩国际和平医院进行异基因造血干细胞移植治疗的急性淋巴细胞白血病患者56例,分析其移植后的近期疗效与远期疗效,通过COX回归模型探讨影响患者预后复发的危险因素。结果56例患者骨髓移植后17 d后TRM为3.5%(2/56);96.4%(54/56)的患者NE细胞植入成功;4例患者血小板植入未成功;植入30 d后49例患者骨髓嵌合率为100%,其他3例患者骨髓嵌合率分别为74.2%、49.6%、58.7%;随访期间12.5%(7/56)的患者出现慢性移植物抗宿主病情况;20例患者出现急性移植物抗宿主病(acute graft-versus-host disease,a GVHD),其中发生多器官a GVHD患者5例;进行移植后3个月内8.9%(5/56)出现死亡,复发率为8.9%(12/56)。3年总生存率为64.7%,无病生存率为61.4%;影响ALL患者移植远期预后复发单因素可能与供体类型、移植前疾病状态、伴髓系表达、预处理剂量和移植方式有关(P<0.05);经COX分析结果显示非相关供体、移植前非CR状态、标准预处理剂量为影响ALL患者移植远期预后复发的危险因素(P<0.05)。结论异基因造血干细胞移植治疗ALL患者近期疗效佳且死亡率低,但复发率高。存在非相关供体、移植前非CR状态、标准预处理剂量的ALL患者远期预后复发危险性高。

Objective To investigate the short-term effects and long-term prognosis of allogeneic hematopoietic stem cell transplantation in treating acute lymphoblastic leukemia（ALL）.Methods Fifty-six cases with ALL treated in our hospital between September 2008 and December 2011 were selected to analyze the short-term and long-term therapeutic effect.COX regression model was used to predict the long-term prognosis.Results Seventeen days after implantation,TRM of 56 cases was 3.5%（2/56）,96.4% of whom（54/56）had successful NE cell implantation.Platelet implantation was not a success in 4 cases.30 d after implantation,the rate of donor chimerism was 100% in 49 cases,but was 74.2%、49.6%、58.7% respectively in other 3 cases.12.5%（7/56）of these cases had chronic graft-versus-host disease（GVHD）,20 had acute graft-versus-host disease（a GVHD）,and 5 cases had multiple organ a GVHD.3 months after implantation,8.9%（5/56）of these cases had TRM death,and relapse rate was 8.9%（12/56）.Three-year overall survival was 64.7%,and leukemia-free survival was 61.4%.Single factors that might have influenced long-term prognosis were donor type,morbid state before implantation,myeloid expression,pretreatment dose and ways of transplantation（P〉0.05）.COX analysis showed that unrelated donors,non-CR status before implantation,and standard pretreatment doses were risk factors for long-term prognosis（P〈0.05）.Conclusion HSCT has better short-term effects in treating ALL,but the recurrence rate is higher.ALL patients with unrelated donors,non-CR status before implantation,and standard pretreatment doses have a higher recurrence rate.