预处理不含抗胸腺细胞球蛋白非血缘脐血移植治疗急性髓系白血病和急性淋巴细胞白血病306例随访评价

Pretreatment of unrelated umbilical cord blood transplantation without antithymocyte globulin for the treatment of acute myeloid leukemia and acute lymphoblastic leukemia:follow-up evaluation of 306 cases

背景:脐血造血干细胞移植作为急性白血病的根治手段,应用越来越广泛,但是其在不同白血病的治疗效果尚无对比,通过分疾病的疗效对比,可指导不同患者进行移植方式的选择。目的:对比分析脐血造血干细胞移植治疗急性髓系白血病和急性淋巴细胞白血病的疗效差异。方法:回顾性分析接受非血缘脐血造血干细胞移植治疗的306例急性白血病患者的临床资料,其中急性淋巴细胞白血病194例,急性髓系白血病112例。所有患者均接受不含抗胸腺细胞球蛋白的清髓性预处理方案,预防移植物抗宿主病为环孢素联合吗替麦考酚酯。结果与结论:①除了急性淋巴细胞白血病移植后的复发率比急性髓系白血病略高以外,两组患者在接受非血缘脐血移植术后的疗效基本一致;②在青少年和年轻成人组(年龄15-39岁),急性髓细胞白血病的中性粒细胞和血小板植入速率均快于急性淋巴白血病白血病,其中CD34+细胞数和预处理方案是针对中性粒细胞植入的独立影响因素,而CD34+细胞数同时也是针对血小板植入的独立影响因素,在该年龄组,急性淋巴细胞白血病患者移植后的复发率依然高于急性髓系白血病,其中慢性移植物抗宿主病是独立影响因素;③移植后免疫重建检测提示,脐血移植后4个月时急性髓系白血病患者的脐血CD8+T细胞重建要优于急性淋巴细胞白血病患者;④上述数据说明,预处理不含抗胸腺细胞球蛋白的非血缘脐血移植对于急性淋巴细胞白血病和急性髓系白血病均有良好的疗效。中国科学技术大学附属第一医院(安徽省立医院)血液科具有干细胞移植资质。

BACKGROUND:Umbilical cord blood hematopoietic stem cell transplantation is more and more widely used as a radical treatment for acute leukemia,but its therapeutic effect in different leukemias has not been compared.By comparing the efficacy of diseases,it can guide different patients to choose the transplantation method.OBJECTIVE:To compare and analyze the therapeutic effect of umbilical cord blood hematopoietic stem cell transplantation on acute myeloid leukemia and acute lymphocytic leukemia.METHODS:Clinical data of 306 cases of acute leukemia treated by unrelated umbilical cord blood hematopoietic stem cell transplantation were retrospectively analyzed,including 112 patients with acute myeloid leukemia and 194 with acute lymphoblastic leukemia.All patients received myeloablative conditioning without antithymocyte,and the prevention of graft-versus-host disease was cyclosporine combined with mycophenolate mofetil.RESULTS AND CONCLUSION:(1)Except that the relapse rate after acute lymphoblastic leukemia transplantation was slightly higher than acute myeloid leukemia,the efficacy of the two groups of patients after receiving unrelated umbilical cord blood hematopoietic stem cell transplantation was basically the same.(2)In the group of adolescents and young adults(aged 15-39 years),the rate of neutrophil and platelet implantation in acute myeloid leukemia was faster than in acute lymphoblastic leukemia.Among them,CD34+cell number and pretreatment program were independent influencing factors for neutrophil implantation,while CD34+cell number was also an independent influencing factor for platelet implantation.In this age group,the recurrence rate of acute lymphoblastic leukemia patients after transplantation was still higher than that of acute myeloid leukemia,in which chronic graft-versus-host disease was an independent influencing factor.(3)Immune reconstruction testing after transplantation suggests that cord blood CD8+T cell reconstruction in patients with acute myeloid leukemia was better than in acute lymphoblastic leukemia patients 4 months after transplantation.(4)The above data show that pre-treatment of unrelated cord blood transplantation without antithymocyte globulin has a good effect on acute lymphocytic leukemia and acute myeloid leukemia.Department of Hematology of The First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China is qualified for stem cell transplantation.