allo-HSCT早期淋巴细胞恢复对急性髓系白血病预后的临床意义

Clinical prognostic significance of early lymphocyte recovery after allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia

目的分析急性髓系白血病异基因造血干细胞移植后早期淋巴细胞恢复对预后的临床意义。方法回顾性分析89例接受异基因外周血造血干细胞移植的急髓系白血病受者的临床资料,用移植后+21天淋巴细胞绝对值(ALC21)代表淋巴细胞恢复速度,分析ALC21对疾病复发、总存活(OS)、无病存活(DFS)等移植疗效的影响。结果移植后ALC21≥0.5×10^9/L组(ALC21高组)的复发率低于ALC21<0.5×10^9/L组(ALC21低组),差异有统计学意义(19.6 %与48.5 %,P=0.004)。两组相比,ALC21高组2年OS[(74.0±6.0)%与(46.5±9.5)%,P=0.002]、2年DFS [(70.5±6.2)%与(44.9±9.3)%,P=0.009]较ALC21低组升高,差异有统计学意义;病毒感染率降低(37.5 %与60.6 %,P=0.035),且ALC21高组受者非复发死亡率(NRM)(P=0.584)、急性移植物抗宿主病(aGVHD,P=0.08)、慢性移植物抗宿主病(cGVHD,P=0.556)均未增加。结论急性髓系白血病异基因造血干细胞移植后早期淋巴细胞恢复对移植后复发及长期预后有明显的早期预测价值。

Objective To analyze the clinical significance of early lymphocyte recovery after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in acute myeloid leukemia. Methods The clinical data of 89 patients with acute myeloid leukemia undergoing allo-HSCT were retrospectively analyzed. The absolute lymphocyte count at Day 21 (ALC21) after allo-HSCT was used for representing the recovery rate of lymphocyte. And the effects of ALC21 on disease relapse, overall survival (OS), disease-free survival (DFS) and other parameters were analyzed. Results The recurrent rate of ALC21 ≥0.5×10^9/L group (high ALC21 group) was significantly lower than that of ALC21 <0.5×10^9/L group (low ALC21 group)(19.6 % vs 48.5 %, P=0.004). The 2-year OS and DFS of high ALC21 group spiked markedly as compared with low ALC21 group [(74.0±6.0 % vs (46.5±9.5)%, P=0.002],[(70.5±6.2)% vs (44.9±9.3)%, P=0.009] while viral infection rate declined markedly (37.5 % vs 60.6 %, P=0.035). However, non-recurrence mortality (NRM), acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD)(P=0.556) were not elevated in high ALC21 group as compared with low ALC21 group (P=0.584, P=0.08, P=0.556). Conclusions Early lymphocyte recovery after in acute myeloid leukemia patients has significant early predictive value for recurrence and long-term prognosis after allo-HSCT.