热带地区异基因造血干细胞移植治疗12例急性白血病的临床分析

Clinical Analysis of Allogeneic Hematopoietic Stem Cell Transplantation for Treatment of 12 Patients with Acute Leukemia in Tropical Area

目的:分析热带地区异基因造血干细胞移植(allo-HSCT)治疗急性白血病的临床疗效。方法:选取中国人民解放军总医院海南医院2013年4月至2018年11月期间行allo-HSCT的12例患者,其中急性淋巴细胞白血病(ALL)5例,急性髓系白血病(AML)7例。3例接受同胞全相合造血干细胞移植,8例接受单倍体相合造血干细胞移植,1例接受非血缘不全相合造血干细胞移植。预处理方案:9例接受改良的BU/CY+ATG预处理方案,3例接受BU/CY预处理方案。移植物抗宿主病(GVHD)的预防均采用环孢素A、吗替麦考酚酯联合短程甲氨蝶呤方案。通过观察移植后患者的造血重建、GVHD、感染、复发及生存情况,分析热带地区allo-HSCT治疗急性白血病的临床疗效。结果:12例患者均获得粒系重建和巨核系重建,粒系植入的中位时间为11.5(6-14)d,巨核系植入的中位时间为12.5(10-22)d。移植后100 d内,8例患者发生急性GVHD,其中Ⅱ-Ⅳ度急性GVHD 6例,Ⅲ-Ⅳ度急性GVHD 2例。11例患者移植后存活超过100 d,1例发生慢性GVHD,为轻度局限型。7例患者发生肺部感染,6例发生巨细胞病毒血症,6例发生EB病毒血症,5例发生出血性膀胱炎。2例患者复发并最终死亡,其余10例病人截止到随访日期均无病存活,中位随访时间为4(1-68)个月,83.3%(10/12)无病存活,16.7%(2/12)复发。结论:allo-HSCT是治疗成人急性白血病的有效方法,白血病患者应在取得缓解状态后尽早进行HSCT,热带地区的移植患者肺部真菌感染发生率较高,应加强真菌感染的预防和治疗。

Objective:To analyze the efficacy of allogeneic hematopoietic stem cell transplantation(allo-HSCT)for treatment of acute leukemia in the tropical area.Methods:Twelve acute leukemia patients who were underwent allo-HSCT from April 2013 to November 2018 in Hainan Hospital of Chinese PLA General Hospital were selected,including 5 cases of acute lymphoblastic leukemia(ALL)and 7 case of acute myeloid leukemia(AML).Three cases received HLA matched sibling hematopoietic stem cell transplantation,8 cases received haploidentical hematopoietic stem cell transplantation,1 cases received partially mismatched unrelated hematopoietic stem cell transplantation.Pretreatment regimen:9 cases received modified BU/CY+ATG pretreatment regimen,3 cases received BU/CY pretreatment regimen.Graft-versus-host disease(GVHD)prevention regimen:all patients received cyclosporine A,mycophenolate mofetil combined with short-term methotrexate regimen.The clinical efficacy of allo-HSCT in treatment of acute leukemia in the tropical area was analyzed by detecting hematopoietic reconstitution,GVHD,infection,relapse and survival after transplantation.Results:All the 12 patients achieved granulocyte reconstruction and megakaryocyte reconstruction.The median time of granulocyte reconstruction was 11.5(6-14)days,and the median time of megakaryocytic reconstruction was 12.5(10-22)days.Within 100 days after transplantation,the acute GVHD occurved in 8 cases,including 6 cases ofⅡ-Ⅳdegree acute GVHD and 2 cases ofⅢ-Ⅳdegree acute GVHD,11 cases survived more than 100 days after transplantation,and the chronic GVHD occurred in 1 case,which was mildly limited.Pulmonary infection occurred in 7 cases,cytomegaloviremia occurred in 6 cases,EB viremia occurred in 6 cases,and hemorrhagic cystitis occurred in 5 cases.2 cases relapsed and eventually died,and the remaining 10 patients survived without disease until the date of follow-up.The median follow-up time was 4(1-68)months,83.3%(10/12)survived without disease,and 16.7%(2/12)relapsed.Conclusion:Allo-HSCT is an effective method for the treatment of acute leukemia in adults.Leukemia patients should be transplanted as soon as possible after remission.The incidence of pulmonary fungal infection in transplanted patients in tropics is high,therefore the prevention and treatment of fungal infection should be strengthened.