第二次移植治疗异基因造血干细胞移植后复发白血病的临床研究

Second allogeneic transplant for leukemia relapsed after first allogeneic transplantation

目的 评价第二次异基因造血干细胞移植 (allo HSCT)治疗allo HSCT后复发白血病的疗效。方法 回顾分析因allo HSCT后复发而进行第二次allo HSCT的 1 0例白血病患者临床资料。其中急性髓系白血病 5例 ,急性淋巴细胞白血病 4例 ,慢性髓系白血病 1例。第一次HSCT后中位复发时间 1 4 1d(34～ 5 4 5d)。第二次HSCT时预处理方案包括 :以中剂量阿糖胞苷 (Ara C)为主的联合化疗 5例 ;以白消安为主的联合化疗 3例 ;含常规剂量Ara C的联合化疗 1例 ;氟达拉宾 /马法兰 1例。移植物抗宿主病 (GVHD)预防方案 :单用环孢菌素 (CsA) 2例 ,CsA +短疗程甲氨蝶呤 1例 ,短疗程他克莫司 1例 ,6例未预防。输注外周血单个核细胞中位数 6 .1× 1 0 8/kg[(1 .9～ 1 1 .8)× 1 0 8/kg]。 结果 可评价的 8例患者均造血重建 ,达中性粒细胞绝对值 >0 .5× 1 0 9/L、血小板 >2 0× 1 0 9/L中位时间分别为移植后 1 1d(3～ 1 7d)、1 2d(9～ 2 3d)。发生Ⅰ度急性GVHD 4例 ,Ⅱ度急性GVHD 3例。可评价的 6例中 5例发生局限型慢性GVHD。 2例无病生存 986d和 1 91 3d。移植相关死亡 5例。复发 3例 ,均死亡。 2年实际无病生存率、移植相关死亡率、复发率分别为 2 0 %、5 0 %和 30 %。结论 第二次allo HSCT是治疗allo

Objective To evaluate the efficacy of second allogeneic hematopoietic stem cell transplantation (allo HSCT) for treatment of leukemia relapsed after first allo HSCT. Methods Nine patients with relapsed acute leukemia (5 AML, 4 ALL) and one with chronic myelogenous leukemia (CML) who showed cytogenetic relapse after first allo HSCT received second allo HSCT. The median relapse time from the first allo HSCT was 141 days. Conditioning regimens for second allo HSCT were combination chemotherapy based on moderate dose Ara C (n=5), Bu (n=3), conventional dose Ara C (n=1) and Flud/Mel (n=1). Prophylaxis for acute graft versus host disease (aGVHD) were CsA alone (n=2), CsA/MTX (n=1), FK506 (n=1) ,and no prophylaxis in 6. The median number of peripheral blood mononuclear cells transfused was 6.1×10 8 /kg. Results Eight cases were evaluable. All of them were engrafted and 7 developed aGVHD (grade Ⅰ 4, grade Ⅱ 3). The median time for absolute neutrophil count (ANC) >0.5×10 9 /L and platelets >20×10 9 /L were 11 and 12 days, respectively. Five cases developed localized chronic GVHD. Of all the 10 cases received second allo HSCT, 8 died from interstitial pneumonia (n=2), multiple organ failure (n=1), sepsis (n=1) , fungous pneumonia (n=1), and leukemia relapse (n=3), and 2 survived without leukemia for +986 and +1913 days, respectively. The leukemia free survival, transplantation related mortality and relapse rate at 2 year were 20%, 50% and 30%, respectively. Conclusion Second allo HSCT is a therapeutic alternative for selected patients with relapsed leukemia after first allo HSCT.