二次移植治疗异基因造血干细胞移植后复发急性髓系白血病5例临床观察

Second allogeneic hematopoietic stem cell transplantation in treatment of relapsed acute myeloid leukemia: clinical report of 5 cases

目的探讨第2次异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)治疗异基因造血干细胞移植后复发的急性髓系白血病患者的临床疗效。方法收集本院2012年1月至2019年6月在allo-HSCT后复发的急性髓系白血病患者5例,经再诱导后(达到CR2-MRD阴性3例;CR2-MRD阳性1例,NR 1例)行清髓性预处理第2次异基因造血干细胞移植(allo-HSCT2),回顾性分析其治疗过程及转归,并分析allo-HSCT2前患者的缓解状态、供者选择、预处理方案等对移植相关并发症、复发死亡(recurrence and death,RM)、移植相关死亡率(transplant-related mortality,TRM)及移植疗效的影响。结果随访至2019年6月30日,5例患者均达到完全供者植入,3例患者17个月内无复发,2例患者allo-HSCT2后因复发死亡。1例发生Ⅰ度急性移植物抗宿主病(acute graft versus host disease,aGVHD)及肺部重度慢性移植物抗宿主病(chronic graft versus host disease,cGVHD)的患者于allo-HSCT2后20个月因呼吸衰竭死亡,其余4例患者未观察到严重的移植相关并发症。allo-HSCT2前骨髓达到完全缓解且微小残留病(minimal residual disease,MRD)阴性的患者预后较好;行二次allo-HSCT与行一次allo-HSCT相比,未增加患者的TRM;对接受第2次异基因造血干细胞移植的患者而言,单倍体移植的移植物抗白血病(graft versus leukemia,GVL)效应与全相合移植相比没有明显的优势。结论第2次异基因造血干细胞移植是治疗异基因造血干细胞移植后复发的急性髓系白血病患者的有效手段。

ObjectiveTo investigate the clinical efficacy and its influencing factors of second allogeneic hematopoietic stem cell transplantation(allo-HSCT2)in acute myeloid leukemia(AML)patients who have relapsed after the first allogeneic transplantation.MethodsClinical data of 5 patients with refractory/relapsed AML who had relapsed after allo-HSCT in our medical center from January 2012 to October 2018 were collected in this study.After re-induction(CR2-MRD-was achieved in 3 cases,CR2-MRD+in 1 case,and NR in 1 case)and myeloablative pretreatment,allo-HSCT2 was conducted to all of them.The clinical process and outcome of these cases were analyzed,and the possible effects of alleviation status,donor selection,pretreatment protocol of the allo-HSCT2 patients before transplantation on the complications,recurrence and death(RM),transplant-related mortality(TRM),and transplantation outcome were also investigated.ResultsUntil the 5 patients were followed up to June 30,2019,all of them achieved complete donor implantation.Three of them had no relapse within 17 months,and 1 patient developed acute graft versus host disease(aGVHD)gradeⅠand chronic graft versus host disease(cGVHD)as severe lung disease,and hence deceased due to respiratory failure in 20 months after the allo-HSCT2.No serious HSCT-related complications were observed in the other 4 patients.The patients with complete remission of allo-HSCT2 with a negative status of(minimal residual disease,MRD),proved to have a better prognosis.Second allo-HSCT did not increase TRM compared with one-time allo-HSCT.For the patients receiving allo-HSCT2,the GVL effect of haploid transplantation had no significant advantage against full-matched HSCT.ConclusionAllo-HSCT2 is an effective therapy for AML patients who relapsed after the first allo-HSCT.