自体外周血造血干细胞移植和自体骨髓移植治疗急性白血病疗效的比较

Comparison of Curative Effect of Autologous Peripheral Blood Stem Cell Transplantation versus Bone Marrow Transplantation for Acute Leukemia

为了比较自体外周血干细胞移植 (APBSCT)与自体骨髓移植治疗CR1 期急性白血病的临床疗效 ,用APB SCT治疗 4 1例 ,用非净化自体骨髓移植 (ABMT)治疗 17例 ,用净化自体骨髓移植 (PABMT)治疗 30例。结果表明 :APBSCT组造血重建显著快于其他两组 ;3组全部病例的 3年无病存活率 (DFS) ,复发率 (RR)和移植相关死亡率(TRM)分别为 5 1.7% ,4 1.7%和 6 .8%。对DFS和RR产生显著影响的是白血病类型 (ALL或AML) ,确诊至CR1 的时间和CR1 至移植时间 3个因素 ;APBSCT组的 3年DFS ,RR和TRM分别为 4 8.4 % ,4 3.9%和 4 .9% ,ABMT组的DFS ,RR ,TRM分别为 4 7.1% ,4 5 .6 %和 11.8% ,PABMT组的DFS ,RR和TRM分别为 6 6 .5 % ,2 9 6 %和 6 .7% ,3组的疗效无显著差异。结论 :APBSCT治疗CR1 期急性白血病的疗效与ABMT和PABMT相当 ,但前者具有造血重建快、采集方便等优势 ,值得临床广泛推广。

To compare the clinical outcome of autologous peripheral blood stem cell transplantation (APBSCT) and autologous bone marrow transplantation (ABMT) in treatment of patients with acute leukemia in first remission, 41 patients received APBSCT, 17 patients received unpurged ABMT and 30 patients received purged ABMT. The results showed that hematopoietic recovery was significantly earlier after APBSCT than that after purged or unpurged ABMT. The 3 year disease free survival (DFS), relapse rate (RR) and transplant related mortality (TRM) for all patients of 3 groups were 51.7%, 41.7% and 6.8% , respectively. DFS and RR were significantly influenced by disease types (ALL or AML) and intervals between diagnosis and CR 1 or CR 1 and transplant. The main causes of transplant related death were infection and hemorrhage. After APBSCT, DFS, RR and TRM were 48.4%, 43.9% and 4.9%, respectively, and did not differ significantly from those found in unpurged ABMT (47.1%, 45.6% and 11.8%) or purged ABMT (66.5%, 29.6% and 6.7%). It is concluded that the clinical outcome of APBSCT is similar to unpurged or purged ABMT but APBSCT allows faster recovery of hematopoiesis and needs less transfusion support.