进展期儿童急性白血病行挽救性造血干细胞移植的疗效分析

A retrospective analysis of salvage allo-HSCT for advanced childhood acute leukemia

目的探讨进展期儿童急性白血病(骨髓原始细胞大于5%)行挽救性异基因造血干细胞移植的疗效。方法选择本中心2016年1月—2018年12月完成的年龄小于18岁的儿童白血病的造血干细胞移植病例,筛选出移植前处于白血病进展期的急性白血病44例患者作为研究对象,对入组病例的临床特征、预后和白血病亚组进行分析统计。结果中位随访时间为44.3(9.0-60.5)个月,3年总体生存率(OS)和无白血病生存率(LFS)分别为28.9%和27.3%。3年0S在急性髓系白血病(AML)组和急性淋巴细胞白血病(ALL)组分别为28.6%和38.5%,未显示出统计学差异(P=0.536)。3年累积复发率为59.1%,AML和ALL两组复发率无显著差异(P=0.807)。死亡原因分析显示:3年累积复发死亡24例,非复发死亡8例。多因素分析显示,复发为影响生存的独立预后不良因素HR=4.38(95%CI:1.820-10.186,P=0.001)。结论无法获得缓解的儿童急性白血病,进展期行挽救性造血干细胞移植,大约1/3的患者可以获得生存,复发仍为主要的死亡原因。

Objective This retrospective analysis aimed to investigate the outcomes of salvage allo-HSCT for advanced childhood acute leukemia.Methods We evaluated the data of 44 patients who have undergone allo-HSCT at advanced leukemia stage(aged<18 years)with intensive myeloablative conditioning regimen between January 2016 and December 2018.The clinical characteristics,prognosis and leukemia subgroups of were analyzed.Results The median follow up time was 44.3 months(range,9.0-60.5)and the 3-year OS and LFS were 28.9% and 27.3% respectively.3-year OS was 28.6% and 38.5%in AML and ALL-group(P=0.536).The cumulative relapse was 59.1%.There was no significant different between AML-group and ALL-group in 3y-cumulative relapse(P=0.807).24 patients died of leukemia recurrence and 8 patients died of non-relapse mortality.Multivariate regression analysis showed that relapse is the independent poor risk factor for OS.HR=4.38(95%CI:1.820-10.186,P=0.001).Conclusions One third of childhood acute leukemia can achieve long-term survival through salvage hematopoietic stem cell transplantation in advanced stage.Recurrence is still the main cause of death.