伴MLL基因重排的急性髓性白血病allo-HSCT治疗50例疗效分析

Outcome of allogeneic hematopoietic stem-cell transplantation in 50 patients with acutemyeloid leukemia and MLL rearrangement

目的探讨异基因造血干细胞移植(allo-HSCT)治疗11q23/MLL阳性急性髓性白血病的疗效。方法回顾分析2012年9月至2019年12月期间在航天中心医院接受allo-HSCT的50例伴11q23/MLL阳性急性髓性白血病受者,通过分析植入成功率,移植物抗宿主病的发生率、感染发生率及移植相关病死(TRM)率、累积复发率、无病存活(DFS)率、总存活(OS)率进行疗效评估。结果50例受者中除1例受者因合并器官功能衰竭,回输细胞后未植活外,其余49例受者顺利植活出仓,白细胞植活的中位时间是15 d(9~18 d),血小板植活的中位时间是13 d(8~33 d)。移植后28 d评估骨髓,49例受者均处于完全缓解(CR)状态。中位随访时间38个月(3~79)个月。移植前缓解组和未缓解组在移植后3年的OS率分别为(83.3±10.8)%、(30.9±8.2)%(P=0.002),DFS率分别为(83.3±10.8)%、(28.4±8.0)%(P=0.003)。结论异基因造血干细胞移植是治疗11q23/MLL重排AML的有效方法,移植前缓解的受者有更高的存活率,移植后复发仍是目前面临的首要问题。

Objective To investigate the efficacy of allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia associated with 11q23/MLL.Methods Retrospection and analysis 50 cases of acute myeloid leukemia with 11q23/MLL and who were treated with allogeneic hematopoietic stem cell transplantation(allo-HSCT)in our hospital from September 2012 to December 2019.The efficacy was evaluated by analyzing the transplantation success rate,graft-versus-host disease rate,infection rate,transplant-related mortality(TRM),accumulative recurrence rate,disease-free survival rate(DFS),and overall survival rate(OS).Results Except for 1 patient had an unsuccessful stem cell transplantationas the result of multiple organ failure,the remaining 49 patients were successfully transplanted.The median time of leukocyte transplantation was 15(9~18)days,and the median time of platelet transplantation was 13(8~33)days.Bone marrow was assessed 28 days after transplantation,and 49 patients were in CR status.The median follow-up time was 38(3~79)months.Between remission group and non-remission group after transplantation,the 3-year OS rates were(83.3±10.8)%,(30.9+8.2)%(P=0.002)and the 3-year DFS rates were(83.3+10.8)%,(28.4±8.0)%(P=0.003),respectively.Conclusions Allogeneic hematopoietic stem cell transplantation is an effective method for the treatment of 11q23/MLL rearranged AML.Patients in remission before transplantation have a higher survival rate,and recurrence after transplantation is the primary problem currently faced.