异基因造血干细胞移植治疗急性髓系白血病的临床分析

Clinical Analysis for Patients with AML Treated after Allo-HSCT

目的:分析异基因造血干细胞移植(allo-HSCT)治疗急性髓系白血病(AML)患者的生存与复发危险因素,并探讨AML复发后的治疗选择。方法:对2009年1月至2018年12月于本中心行allo-HSCT术后处于完全缓解(CR)期的180例AML患者进行回顾性分析,应用COX比例风险模型进行单因素和多因素分析,探讨影响移植后生存及复发的危险因素。结果:180例患者中,134例(74.4%)存活,46例(25.6%)死亡,40例(22.2%)复发。移植后5年总生存(OS)率、无事件生存(EFS)率、累积复发率分别为74.3%、42.5%和25.0%。AML危险分层为高危组、伴高危细胞遗传学、移植前为CR2期以及未发生慢性移植物抗宿主病(cGVHD)是影响移植后OS的独立危险因素;移植前为CR2期、AML危险分层高危组是影响移植后EFS的独立危险因素;AML危险分层高危组、单疗程诱导治疗后微小残留病MRD+、伴高危细胞遗传学、未发生cGvHD是影响移植后复发的独立危险因素。移植后应用去甲基化药物(HMA)辅以G-CSF动员的供者淋巴细胞输注(DLI)维持治疗可提高移植后复发患者的总生存率,2年OS率为62.5%。结论:allo-HSCT可大大提高AML患者的生存率,但移植后复发仍为影响生存的主要因素之一。应用HMA联合DLI维持治疗可能成为治疗移植后复发患者新的有效方法。

Objective:To analyze risk factors that affect survival and relapse of AML patients after allogeneic hematopoietic stem cell transplantation(allo-HSCT),and to investigate the therapy choices after AML relapse.Methods:Clinical data of 180 AML patients achieved complete remission(CR)before HSCT from January 2009 to December 2018 treated in our center were analyzed retrospectively.Risk factors for survival and relapse after allo-HSCT were analyzed by COX regression.Results:Among 180 AML patients,134 survived(74.4%),46 patients died(25.6%),and 40 patients relapsed(22.2%).The rate of overall survival(OS),event-free survival(EFS)and cumulative rate of relapse in 5-years was 74.3%、42.5%and 25.0%,respectively.High-risk,adverse cytogenetics,CR2 at HSCT and no cGvHD were independent risk factors that affect OS.CR2 at HSCT,high-risk were independent risk factors that affect EFS.High-risk,MRD+after one course of induction therapy,adverse cytogenetics and no cGVHD were independent risk factors that affect relapse.The OS rate of relapse patients could be improved by the usage of hypomethylation agents combined with G-CSF mobilized donor lymphocyte infusion(DLI),and 2-year OS rate was 62.5%.Conclusion:The survival rate of AML is greatly improved by allo-HSCT,but relapse is still one of the most important factors that influence survival of the AML patients.The maintenance therapy of hypomethylation agents combined with DLI may be a new effective treatment option for patients who relapse after HSCT.