移植前血液形态学完全缓解状态对单倍型相合造血干细胞移植治疗B-ALL预后的影响

Effects of hematological complete remission status before transplantation on outcomes of patients with B-cell acute lymphoblastic leukemia receiving haploidential stem cell transplantation

目的探讨接受单倍型相合造血干细胞(Haplo-SCT)的B细胞系急性淋巴细胞白血病(B-ALL)患者移植前血液学缓解(HCR)状态对预后的影响。方法回顾性分析2012年9月至2016年6月北京大学血液病研究所接受Haplo-SCT且移植前均获得HCR的317例B-ALL患者。采用Cox模型分析移植前HCR状态对317例接受Haplo-SCT的B-ALL患者预后的影响。结果 317例患者3年非复发死亡(NRM)、累计复发(CIR)、无病生存(LFS)及总生存(OS)率分别为15%、15%、71%和74%。HCR伴外周血中性粒细胞(ANC)和血小板(PLT)恢复(CR)组、ANC未恢复伴或不伴PLT恢复(CRi)组和ANC恢复伴PLT未恢复(CRp)组的3年NRM、CIR和LFS率的差异均无统计学意义(P均>0.05);CR组患者3年OS率高于CRi组(76%vs 59%,P=0.049)。移植前微小残留病(P=0.006)和慢性移植物抗宿主病(GVHD)(P=0.020)影响CIR;PLT植入影响NRM、LFS和OS(P值均<0.001);Ⅲ~Ⅳ度急性GVHD影响NRM(P<0.001)和OS(P=0.035);慢性GVHD影响LFS(P<0.001)。结论移植前HCR状态不影响接受Haplo-SCT的B-ALL患者的预后。

Objective To investigate the association of hematological complete remssion(HCR) status on the outcomes of the patients with B-cell acute lymphoblastic leukemia(B-ALL) who were undergoing haploidentical stem cell transplantation(Haplo-SCT). Methods Retrospective analysis was performed on 317 patients with B-ALL who received Haplo-SCT with HCR before transplantation in the Institute of Hematology, Peking University from September 2012 to June 2016. A Cox proportional hazards model was used to analyze the effects of HCR status before transplantation on the outcomes of Haplo-SCT. Results The 3-year cumulative incidences of non-relapse mortality(NRM) and cumulative incidence of relapse(CIR) were 15% and 15%, respectively. The 3-year probabilities of leukemia-free survival(LFS) and overall survival(OS) were 71% and 74%, respectively. There was no statistical difference for 3-year NRM, CIR and LFS among the HCR patients with recovery of absolute neutrophil count(ANC) and platelet(CR) group, without recovery of ANC and with or without recovery of platelet(CRi) group and those in HCR with recovery of ANC but without recovery of platelet(CRp) group(P value >0.05 for all). The probability of OS in cases of CR group was significantly higher than that of CRi group(76% vs 59%,P=0.049). Multivariate analysis showed that factors associated with CIR included pre-transplantation minimal residual disease(P=0.006) and chronic GVHD(P=0.020). Platelet engraftment was associated with NRM, LFS, and OS(P<0.001 for all). Grades Ⅲ-Ⅳ GVHD was associated with NRM(P<0.001) and OS(P=0.035). Chronic GVHD was correlated with LFS(P<0.001). Conclusion Our results indicate that no effect of HCR status before transplant on the outcomes was observed in patients with B-ALL who underwent Haplo-SCT.