亲缘单倍型和同胞相合造血干细胞移植治疗完全缓解期急性T淋巴细胞白血病疗效比较

Comparison of the clinical outcomes of haploidentical and matched-sibling donor stem cell transplantation for T cell acute lymphoblastic leukemia in complete remission

目的比较亲缘单倍型造血干细胞移植(HIDT)和同胞相合造血干细胞移植(MSDT)治疗完全缓解期(CR)急性T淋巴细胞白血病(T-ALL)的疗效。方法回顾性分析2012年5月至2017年5月间在河北燕达陆道培医院接受HIDT(81例)和MSDT(17例)的CR期T-ALL患者的临床特点和预后。结果HIDT组、MSDT组移植后100 dⅡ~Ⅳ度急性GVHD发生率分别为51.9%(95%CI 42.0%~64.0%)、29.4%(95%CI 14.1%~61.4%)(P=0.072),Ⅲ/Ⅳ度急性GVHD发生率分别为9.8%(95%CI 5.1%~19.1%)、11.8%(95%CI 3.2%~43.3%)(P=1.000),巨细胞病毒(CMV)血症发生率分别为53.1%(95%CI 43.3%~65.2%)、29.4%(95%CI 14.1%~61.4%)(P=0.115),EB病毒(EBV)血症发生率分别为35.8%(95%CI 26.8%~47.9%)、11.8%(95%CI 3.2%~43.3%)(P=0.048)。HIDT、MSDT两组移植后5年总生存(OS)率分别为60.5%(95%CI 5.4%~49.0%)、68.8%(95%CI 11.8%~40.0%)(P=0.315),无白血病生存(LFS)率分别为58.0%(95%CI 5.5%~46.5%)、68.8%(95%CI 11.8%~40.0%)(P=0.258),累积复发率分别为16.1%(95%CI 9.8%~26.4%)、11.8%(95%CI 3.2%~43.3%)(P=0.643),非复发死亡率(NRM)分别为25.9%(95%CI 17.9%~37.5%)、19.4%(95%CI 6.9%~54.4%)(P=0.386)。结论对于CR期T-ALL患者,当缺乏合适供者时,HIDT可作为替代选择。

Objective To compare the efficacy of haplotype hematopoietic stem cell transplantation(HIDT)and sibling matched hematopoietic stem cell transplantation(MSDT)in the treatment of complete remission(CR)acute T-lymphoblastic leukemia(T-ALL).Methods We retrospectively analyzed the clinical characteristics and outcomes of 98 patients who underwent HSCT in Hebei Yanda Ludaopei hospital with HID(n=81)or ISD(n=17)between May 2012 and May 2016.Results The incidence of grades 2-4 and 3-4 acute-versus-host disease 100 days after HSCT were 51.9%(95%Confidence interval[CI]42.0%-64.0%)vs 29.4%(95%CI 14.1%-61.4%)(P=0.072)and 9.8%(95%CI 5.1%-19.1%)vs 11.8%(95%CI 3.2%-43.3%)(P=1.000)for HIDT and MSDT.The 100-day cumulative incidences of CMV and EBV viremia were 53.1%(95%CI 43.3%-65.2%)vs 29.4%(95%CI 14.1%-61.4%)(P=0.115)and 35.8%(95%CI 26.8%-47.9%)vs11.8%(95%CI 3.2%-43.3%)(P=0.048).The 5-year overall survival,leukemia-free survival,cumulative incidences of relapse,and no-relapse mortality were 60.5%(95%CI 5.4%-49.0%)vs 68.8%(95%CI 11.8%-40.0%)(P=0.315),58.0%(95%CI 5.5%-46.5%)vs 68.8%(95%CI 11.8%-40.0%)(P=0.258),16.1%(95%CI 9.8%-26.4%)vs 11.8%(95%CI 3.2%-43.3%)(P=0.643),25.9%(95%CI 17.9%-37.5%)vs 19.4%(95%CI 6.9%-54.4%)(P=0.386)for HIDT and MSDT,respectively.Conclusion HID could be a valid alternative donor for patients with T-ALL in CR lacking an identical donor.