异基因造血干细胞移植治疗急性髓系白血病单中心临床疗效分析

Analysis on single-center clinical effect of allogeneic hematopoietic stem cell transplantation for treatment of acute myeloid leukemia

目的总结并分析异基因造血干细胞移植(allo-HSCT)治疗急性髓系白血病(AML)临床疗效。方法回顾性分析2008年1月至2015年6月于该院接受allo-HSCT的87例AML患者临床资料,分析移植后患者总生存率(OS)、无白血病生存率(LFS)和复发率(RR)、移植相关死亡率(TRM),并对人类白细胞抗原(HLA)全相合(亲缘和非血缘)与半相合移植疗效进行比较,同时分析不同移植前白血病缓解状态对移植疗效的影响。结果 87例患者移植后的2年OS为(73.6±4.7)%,2年LFS为(62.1±5.8)%。随访期中有27例(31.3%)复发,23例(26.4%)死亡。HLA全相合(亲缘和非血缘)与HLA半相合移植后的2年OS分别为(76.3±5.3)%、(68.5±7.2)%(P<0.05),2年LFS分别为(60.2±4.8)%、(56.3±5.7)%(P>0.05)。HLA半相合移植急性移植物抗宿主病(aGVHD)和感染发生率明显高于HLA全相合(亲缘和非血缘)移植,但两者RR相似分别为26.9%、29.2%(P>0.05)。不同白血病缓解状态的移植疗效分析显示移植前未达到完全缓解(CR)、达到CR但微小残留(MRD)阳性和MRD阴性3组RR分别为68.7%、34.7%、16.6%,2年LFS分别为(18.7±5.2)%、(56.5±6.3)%、(79.2±5.7)%(P<0.05);2年OS分别为(31.2±5.3)%、(69.6±7.2)%、(89.6±5.3)%(P<0.05)。结论异基因造血干细胞移植是治疗AML的有效方法,复发是移植治疗后失败的主要原因。

Objective To summarize and analyze the clinical effect of allogeneic hematopoietic stem cell transplantation（allo- HSCT） for treating acute myeloid leukemia（AML） in this center. Methods The clinical data of 87 patients with AML receiving allo-HSCT in this hospital from January 2008 to June 2015 were retrospectively analyzed on the overall survival rate（OS） after trans- plantation,leukemia-free survival rate （LFS） and relapse rate （RR）, transplant-related mortality （TRM）, moreover the efficacies of HLA-matched （kinship and unrelated） and haploidentical transplantation Were compared. Meanwhile the influence of different transplantation of pre-leukemia remission status on transplantation curative effect was analyzed. Results Among 87 cases,OS after 2 years was （73.6±4.7）% and 2-year LFS was （62. 1±5. 8）%. During the follow-up period,27 cases （31.3;） relapsed and 23 cases （26.4%） died. The 2-year OS in HLA-matehed （kinship and unrelated） and haploidentical transplantation were （76. 3 ± 5.3）% and （68. 5±7.2）% respectively（P〈0. 05） and the 2-year LFS were （60. 2±4. 8）% and （56.3±5.7）; respectively （P〉 0.05）. The incidence rate of aGVHD and infection in haploidentical transplantation group was significantly higher than that in the HLA matched group （kinship and unrelated）, but their RR were 26.9% and 29.2% respectively （P;0.05）. The transplantation effect analysis in different leukemia remission state showed that RR in the unreaching CR before transplantation group,reaching CR but minimal residual （MRD） positive group and negative group were 68.7 %,34.7% and 16.6 % respectively. The 2-year LFS were （18.7±5.2）%,（56.5±6.3）% and （79.2±5. 7）% respectively （P〈0. 05）. The 2-year OS were （31.2±5.3）%,（69.6±7.2） ; and （89.6 ±5.3） % respectively （P〈0.05）. Conclusion allo-HSCT is an effective method for treating AML. Recurrence is the main cause of failure after transplantation therapy.