复发难治急性髓系白血病异基因造血干细胞移植疗效及预后因素分析

Analysis of efficacy and prognostic factors of allogeneic hematopoietic stem cell transplantation in treatment of relapsed/refractory acute myeloid leukemia

目的探讨异基因造血干细胞移植(allo-HSCT)治疗复发难治急性髓系白血病(AML)的效果及影响预后的相关因素。方法回顾性分析2011年6月至2018年10月于郑州大学附属肿瘤医院行allo-HSCT治疗的35例复发难治AML患者临床资料。分析移植物抗宿主病(GVHD)发生率、移植后总生存(OS)率、无病生存(DFS)率、移植相关死亡率及复发率,并分析影响预后的危险因素。结果移植后所有患者均获得造血重建。100 dⅡ~Ⅳ度急性GVHD发生率为(22.9±7.7)%,3年慢性GVHD发生率为(49.5±10.6)%。移植后中位随访时间为14.1个月(4.2~89.4个月),18例生存(其中16例DFS),17例死亡;14例患者复发,中位复发时间为4.7个月(2.9~32.4个月)。移植后3年OS率、DFS率分别为(44.4±9.3)%、(43.0±9.5)%。单因素分析显示,移植前疾病未缓解、移植前不良遗传学危险度分组、移植后复发为影响OS的危险因素(均P<0.05)。移植前完全缓解组和移植前未缓解组的3年OS率分别为(63.2±12.0)%、(15.7±12.8)%(P=0.025),3年DFS率分别为(62.2±12.3)%、(15.3±12.7)%(P=0.028),3年复发率分别为(28.2±10.7)%、(80.6±15.7)%(P=0.057)。移植前遗传学高危组患者移植后3年复发率较中危组及低危组高,三组分别为100.0%、(45.0±12.1)%、(14.3±13.2)%(P=0.045)。移植后3年移植相关死亡率为(18.7±7.7)%。结论allo-HSCT是挽救性治疗复发难治AML的有效手段,复发是影响生存的主要因素,移植前降低肿瘤负荷对减少复发和提高疗效至关重要。

Objective To explore the efficacy and prognostic factors of allogeneic hematopoietic stem cell transplantation(allo-HSCT)in the treatment of relapsed/refractory acute myeloid leukemia(AML).Methods The clinical data of 35 patients with relapsed/refractory AML treated with allo-HSCT in the Affiliated Cancer Hospital of Zhengzhou University from June 2011 to October 2018 was retrospectively analyzed.The overall survival(OS),disease-free survival(DFS),graft versus host disease(GVHD)incidence,transplantation related mortality and recurrence rate were calculated,and the risk factors affecting prognosis were analyzed.Results Hematopoietic reconstitution was obtained in all patients after transplantation.The 100 d incidence of gradeⅡ-Ⅳacute GVHD was(22.9±7.7)%,and the 3-year incidence of chronic GVHD was(49.5±10.60)%.The median follow-up time after transplantation was 14.1 months(4.2-89.4 months).In all cases,18 cases survived(including 16 cases of DFS),and 17 cases died.Fourteen cases relapsed,and the median recurrence time was 4.7 months(2.9-32.4 months).The 3-year OS rate and DFS rate were(44.4±9.3)%and(43.0±9.5)%,respectively.Univariate analysis showed that the non-remission disease before transplantation,poor genetic risk grade before transplantation and recurrence after transplantation were the risk factors for OS(all P<0.05).The 3-year OS rates in complete remission before transplantation group and non-remission before transplantation group were(63.2±12.0)%and(15.7±12.8)%(P=0.025),the 3-year DFS rates were(62.2±12.3)%and(15.3±12.7)%(P=0.028),and the 3-year recurrence rates were(28.2±10.7)%and(80.6±15.7)%(P=0.057).The 3-year recurrence rate in genetic high-risk group was higher than that in middle-risk group and low-risk group[100.0%,(45.0±12.1)%and(14.3±13.2)%,P=0.045].The 3-year tansplantation related mortality was(18.7±7.7)%.Conclusions Allo-HSCT is an effective method for salvage treatment of relapsed/refractory AML,and recurrence is the main factor affecting survival.Reducing tumor load before transplantation is very important for reducing recurrence and improving curative effect.