异基因造血干细胞移植治疗100例白血病的临床总结

发布时间：2019-02-13 10:59

【摘要】：目的:分析异基因造血干细胞移植(allo-HSCT)治疗100例白血病的疗效。方法:回顾性分析100例接受allo-HSCT的白血病患者临床资料,总结治疗效果。在100例患者中急性髓系白血病(AML)47例,急性淋巴细胞白血病(ALL)33例,急性白血病(混合细胞型)(HAL)2例,慢性髓系细胞白血病(CML)16例,慢性粒单核细胞白血病(CMML)2例。移植前处于第1次完全缓解期(CR1)76例,第2次及以上缓解期9例,未缓解15例。造血干细胞均来自外周血。人类白细胞抗原(HLA)配型全相合移植预处理多数采用改良白舒非+环磷酰胺(Bu Cy)方案,移植物抗宿主病(GVHD)预防采用经典环孢素A(Cs A)加短疗程甲氨蝶呤(MTX)方案;HLA配型不全相合移植预处理采用氟达拉滨(Flu)+Bu Cy+抗人胸腺细胞球蛋白(ATG),GVHD预防采用Cs A+短疗程MTX+吗替麦考酚酯(MMF)。平均随访时间为13个月。结果:至随访终点,66.0%(66/100)存活,53.0%(53/100)无病存活,28.0%(28/100)复发,34.0%(34/100)死亡,其中44.1%死于重症肺炎。65.0%的患者移植当次发生肺部感染。所有患者移植后的3年总体生存率(OS)为(60.9±5.5)%,3年无病生存率(DFS)为(48.8±5.6)%。未缓解期移植的复发率(66.7%)明显大于缓解期移植(21.2%)(P0.05)。不全相合移植GVHD的发生率(60.8%)明显高于全相合移植(38.8%)(P0.05)。结论:肺部感染仍是当前造血干细胞移植面临的一大重要难题。白血病患者应在取得CR1后尽早进行移植,复发病人的移植也应争取在缓解状态下进行。全相合移植综合预后优于不全相合移植。
[Abstract]:Objective: to analyze the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of 100 cases of leukemia. Methods: the clinical data of 100 leukemia patients receiving allo-HSCT were analyzed retrospectively. There were 47 cases of acute myeloid leukemia (AML), 33 cases of acute lymphoblastic leukemia (ALL), 2 cases of acute leukemia (mixed cell type) (HAL), 16 cases of chronic myeloid leukemia (CML). Two cases of chronic myelogenous monocytic leukemia (CMML). Before transplantation, 76 cases were in the first complete remission period (CR1), 9 cases were in the second or more stage of remission, and 15 cases had no remission. All hematopoietic stem cells come from peripheral blood. Human leukocyte antigen (HLA) matched transplantation was pretreated with modified Baishu non-cyclophosphamide (Bu Cy) regimen. Graft-versus-host disease (GVHD) was prevented by classical cyclosporine (A (Cs A) plus short course methotrexate (MTX) regimen. Preconditioning of HLA mismatched transplantation with fludarabine (Flu) Bu Cy anti-human thymocyte globulin (ATG), GVHD prevention with Cs A short course of MTX mycophenolate mofetil (MMF). The average follow-up time was 13 months. Results: at the end of follow-up, 66.0% (66 / 100) survived, 53.0% (53 / 100) survived without disease, 28.0% (28 / 100) recurred, 34.0% (34 / 100) died. Among them, 44.1% died of severe pneumonia and 65.0% suffered from pulmonary infection. The overall 3-year survival rate (OS) was (60.9 卤5.5)%, and the 3-year disease-free survival rate (DFS) was (48.8 卤5.6)%. The recurrence rate of non-remission transplantation (66.7%) was significantly higher than that of remission transplantation (21.2%) (P0.05). The incidence of GVHD was significantly higher (60.8%) than that of homocompatibility (38.8%) (P0.05). Conclusion: pulmonary infection is still an important problem in hematopoietic stem cell transplantation. Leukemia patients should be transplanted as soon as possible after obtaining CR1, and the transplant of recurrent patients should also be carried out in remission. The comprehensive prognosis of complete matching transplantation is better than that of incomplete matching transplantation.
【作者单位】：南方医科大学珠江医院血液科;
【基金】：国家自然科学基金项目(81372249) 广东省产学研项目(2013B091500072)
【分类号】：R457.7;R733.7

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