高危白血病移植后复发行供者淋巴细胞输注治疗的疗效分析

Efficacy of Donor Lymphocyte Infusion for Treating Relapsed High-Risk Leukemia patients after Allogeneic Hematopoietic Stem Cell Transplantation

目的:探讨供者淋巴细胞输注(donor lymphocyte infusion,DLI)治疗异基因造血干细胞移植(allo-HSCT)后复发的高危白血病患者的疗效。方法:回顾性分析2000年8月至2015年4月期间在南方医科大学珠江医院行allo-HSCT后复发而予以供者淋巴细胞输注的15例高危白血病患者,以及期间行allo-HSCT后复发而未予以供者淋巴细胞输注的13例高危白血病患者,并对两类患者的1和3年OS率进行对比。结果:行DLI的15例患者的1和3年生存率分别为58.3%和46.7%,1和3年DFS率分别为22.0%和11.0%,患者的死亡原因主要为疾病复发(5例),急性GVHD反应(1例)。未行DLI术的13例患者1年和3年OS率分别为29.9%和15.0%,1年DFS率为11.2%,患者的死亡原因主要为疾病复发(9例)。移植后复发行DLI治疗的患者与未行DLI的患者相比,移植后复发行DLI治疗的患者的1和3年OS率均高于未行DLI患者,但两者OS率差异无统计学显著性(P=0.069)。结论:DLI治疗仍然是目前治疗移植后复发的较为有效的方法,联合其他方式或改变供者淋巴细胞的细胞输注类型或将可以提高DLI的疗效。

Objective:To investigate the efficacy of donor lymphocyte infusion(DLI) for treating relapsed high-risk leukemia patients after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:The data of 15 leukemia patients who had received DLI and 13 leukemia patients who had not received DLI in Zhujiang Hospital from2000 to 2014 were studied retrospectively,and their 1 and 3 year overall survival rate(OS) were compared between the two groups.Results:In 15 patients received DLI,the 1 and 3 year OS were 58.3%and 46.7%,the 1 and 3 year disease-free survival(DFS) were 22.0%and 11.0%,respectively.The main death cause in these patients included relapse(n = 5) and acute GVHD(n = 1),whereas in 13 patients who had not received DLI,the 1 and 3 year OS were29.9%and 15.0%respectively,their 1 year DFS were 11.2%.The main death cause in these patients were relapse(n= 9).The 1 and 3 year OS of patients who had received DLI was higher as compared with the patients who had not received DLI.but this difference was no statistically significant(P = 0.069).Conclusion:DLI is an effective method for treating patients with relapsed leukemia,and may improve the therapeutic efficacy of DLI by combining other methods or alternating the types of the donor lymphocytes.