异基因造血干细胞移植治疗慢性粒单核细胞白血病的临床研究

Allogeneic hematopoietic stem cell transplantation for chronic myelomonocytic leukemia

目的评估异基因造血干细胞移植(allo-HSCT)治疗慢性粒单核细胞白血病(CMML)的疗效。方法回顾性分析我院接受allo-HSCT的19例CMML受者的临床资料,通过观察受者在接受allo-HSCT后造血植入、移植物抗宿主病(GVHD)、感染、复发、脾大及存活情况,分析allo-HSCT治疗CMML的临床疗效。结果2例受者于移植后早期死亡未获得造血重建,余17例受者均获得粒细胞重建,中位植入时间为14 d(11~18)d,其中15例受者获得粒细胞、血小板重建,血小板中位植入时间为15 d(12~70)d。8例受者发生急性GVHD(5例Ⅰ度、3例Ⅱ~Ⅳ度);8例受者发生慢性GVHD(5例为广泛型)。10例(52.6%)受者在移植前脾脏明显肿大(SPM),有8例受者移植后复查超声,脾脏无明显缩小的4例受者均死亡,而明显缩小的4例受者均存活。中位随访时间31个月(6~68个月),3年总体存活率(58.2±12.5)%、无病存活率(36.3±14)%、累积复发率(39.9±19)%、非复发死亡率(37±12.6)%。结论allo-HSCT是治疗CMML的有效手段,能改善CMML受者的长期存活;移植前SPM及移植后脾脏无明显缩小可能是预后不良因素。

Objective To explore the therapeutic efficacy of allogeneic hematopoietic stem cell transplantation(allo-HSCT)in chronic myelomonocytic leukemia(CMML)patients.Methods The clinical data were retrospectively analyzed for 19 CMML patients undergoing allo-HSCT.Engraftment,graft versus host disease(GVHD),infection,relapse,splenomegaly and survival were observed.And the clinical outcomes of allo-HSCT for CMML were analyzed.Results Hematopoiesis reconstitution was not attained in 2 recipients due to early death post-transplantation.Neutrophil engraftment was obtained in 17 recipients with a median time of 14(11-18)days.Neutrophil engraftment and platelet engraftment were achieved in 15 recipients with a median time of platelet engraftment at 15(12~70)days.Seven patients developed acute GVHD(grade 1,n=5;grade 2~4,n=3)while another 8 patients had chronic GVHD(extensive,n=5).Ten patients(52.6%)had palpable splenomegaly(SPM)before allo-HSCT,8 patients were diagnosed ultrasonically after transplantation,all 4 patients without a significant reduction of spleen died while all 4 patients with a significant reduction of spleen survived.After a median follow-up period of 31(6-68)months,3-year overall survival(OS),disease-free survival(DFS),cumulative incidence of relapse(CIR)and non-relapse mortality(NRM)were(58.2±12.5)%,(36.3±14)%,(39.9±19)%and(37±12.6)%respectively.Conclusions As an effective therapy for CMML,allo-HSCT may improve the survival of CMML patients.Palpable SPM pre-transplantation and no significant reduction post-transplantation are probably poor prognostic factor.