外周血异基因造血干细胞移植治疗急性白血病疗效分析

Peripheral Blood Allogeneic Hematopoietic Stem Cell Transplantation for Acute Leukemia

目的评估外周血异基因造血干细胞移植治疗急性白血病的疗效。方法回顾性分析医院2014年12月至2018年12月收治的拟行异基因造血干细胞移植的97例急性白血病患者的早期(移植后100 d内)及长期疗效,计算3年总生存率(OS)及3年无病生存率(DFS),并对可能影响疗效的因素进行统计与分析。结果移植后的死亡原因主要有颅内出血、急性移植物抗宿主病(aGVHD)及感染性休克;移植100 d后的死亡原因主要为复发;3年OS及DFS分别为63.5%和58.5%;多因素分析示,预后不良的独立危险因素有重度aGVHD[RR=5.466,95%CI(1.556,19.196),P=0.008]及造血重建期间血小板输注量≥5 U[RR=2.34,95%CI(1.078,5.082),P=0.032]。结论外周血异基因造血干细胞移植是治疗急性白血病的有效方法,植入不良、aGVHD、感染性休克及复发是移植治疗失败的主要原因。重度a GVHD及造血重建期间血小板输注量≥5 U是导致患者预后不良的独立危险因素。

Objective To evaluate the efficacy of peripheral blood allogeneic hematopoietic stem cell transplantation for acute leukemia.Methods A total of 97 patients with acute leukemia who received peripheral blood allogeneic hematopoietic stem cell transplantation from December 2014 to December 2018 in the hospital were collected;their early(within 100 d after the transplantation)and long-term efficacy were retrospectively analyzed,the 3-year overall survival(OS)and disease free survival(DFS)were calculated,and the potential risk factors that might affect the efficacy were statistically analyzed.Results The major causes of death after transplantation were intracranial hemorrhage,acute graft versus host disease(aGVHD),and infectious shock.The 3-year OS and DFS were 63.5%and 58.5%,respectively;multivariate analysis revealed severe a GVHD[RR=5.466,95%CI(1.556,19.196),P=0.008]and platelet transfusion≥5 U[RR=2.34,95%CI(1.078,5.082),P=0.032]were the poor prognostic factors for these patients.Conclusion Peripheral blood allogeneic hematopoietic stem cell transplantation is an effective choice for patients with acute leukemia.The major causes of death after transplantation are poor implant,a GVHD,infectious shock and relapse.Severe aGVHD and platelet transfusion≥5 U are poor prognostic factors for acute leukemia patients received Peripheral blood allogeneic hematopoietic stem cell transplantation.