亲缘外周血单倍体造血干细胞移植治疗复发难治急性白血病的临床分析

Clinical analysis of genetic haploidentical peripheral blood stem cell transplantation on relapsed and refractory acute leukemia

目的观察亲缘外周血单倍体造血干细胞移植治疗复发难治急性白血病的临床疗效。方法对57例复发难治急性白血病行外周血单倍体造血干细胞移植的临床资料进行回顾性分析，其中急性淋巴细胞白血病（ALL）43例，急性髓系白血病14例（AML）；外周血单倍体移植预处理方案采用改良的BU／CY＋ATG方案，均应用环孢素A＋吗替酶酚酸酯＋短程甲氨蝶呤±巴利昔单抗预防移植物抗宿主病（GVHD）。结果57例复发难治急性白血病移植患者中位随访时间32个月（2—65个月）；其中粒细胞缺乏期感染率为84．2％（48／57）；粒细胞植入率为98．2％（56／57），中位植入时间14d（10～22d），巨核系植入率为91．2％（52／57），中位植入时间20d（10—90d）；GVHD累计发生率为61．4％（35／57），其中急性GVHD占26．3％（15／57），慢性GVHD占35．1％（20／57）；出血性膀胱炎发生率为36．8％（21／57）；移植后复发率为24．6％（14／57），2例出现移植后淋巴细胞增生性疾病（PTLD）；57例患者3年内非复发病死率为31．6％（18／57）；3年总生存率为44％，3年无病生存率为40％。结论在无人类白细胞抗原（HLA）同胞相合及非血缘相合供者的情况下，亲缘外周血单倍体造血干细胞移植治疗复发难治急性白血病是一种有效可行的方法。

Objective To observe the clinical efficacy of genetic haploidentical peripheral blood stem cell transplantation on relapsed and refractory acute leukemia. Methods The clinical data of 57 patients with relapsed and refractory acute leukemia who accepted genetic haploidentical peripheral blood stem cell transplantation were retrospectively analyzed, including 43 cases of acute lymphoblastic leukemia （ALL）, 14 cases of acute myeloid leukemia （AML）. Haploidentical peripheral blood stem cell transplantation using ＂modified BU/CY ＋ ATG＂ ; applying ＂cyclosporine A ＋ mycophenolate mofetil ＋ short-range methotrexate ＋ basiliximab＂ to prevent graft-versus-host disease. Results Fifty-seven patients with relapsed and refractory acute leukemia were followed for an median of 32 months （2-65 months）, infection rate of granulocyte lack period was 84. 2% （48/57） ; the incidence of neutrophil reconstruction was 98.2% （56/57）, the median implanted time was 14 d （10-22 d）, the rate of platelet engraftment was 91.2% （52/57）, median implanted time was 20 d （10-90 d） ; the incidence of GVHD was 61.4% （ 35/57 ）, including acute GVHD [ 26.3% （ 15/57 ） ], the incidence of chronic GVHD was 35.1% （20/57） ; the incidence of hemorrhagic cystitis was 36. 8% （21/57） ; the recurrence rate after transplantation was 24. 6% （14/57）, 2 cases got posttransplant lymplaoproliferative disease; the nonrelapse mortality was 31.6% （ 18/57 ） ; 3 years overall survival was 44% , 3 year disease-free survival was 40%. Conclusions In the absence of HLA-identical siblings donors and unrelated donor, genetic haploidentical peripheral blood stem cell transplantation for treatment of relapsed and refractory acute leukemia is an effective and feasible method.