CAJ | 학술논문

目的：观察清髓性异基因造血干细胞移植（allo-HSCT）治疗进展期难治性急性髓系白血病（AML）的临床疗效。方法对31例未缓解期难治性AML患者，采用改良马利兰+环磷酰胺（24例）或全身放疗+环磷酰胺（7例）的清髓性预处理方案行allo-HSCT，采用环孢菌素A（CsA）加短程甲氨蝶呤（MTX）预防移植物抗宿主病（GVHD），部分患者加入霉酚酸酯（MMF）。结果27例患者成功获得造血重建，中性粒细胞>1.0×109/L和血小板>20×109/L的中位时间分别为12（10~14）d和13（10~16）d。急性GVHD发生率为42.3%（11/27），可评估的23例患者中8例发生慢性GVHD，均为局限性。移植相关病死率为22.6%（7例），移植后成功获得完全缓解的25例患者中8例血液学复发，其中3例合并髓外复发，复发率为32%。中位随访23（4~93）个月，至今有14例患者无病生存（DFS），2年DFS为45.4%。结论 allo-HSCT治疗进展期难治性AML仍不失为一种有效的挽救手段，其中发生慢性GVHD的患者预后较好，而移植相关并发症及移植后复发是影响患者生存的主要因素。
목적：관찰청수성이기인조혈간세포이식（allo-HSCT）치료진전기난치성급성수계백혈병（AML）적림상료효。방법대31례미완해기난치성AML환자，채용개량마리란+배린선알（24례）혹전신방료+배린선알（7례）적청수성예처리방안행allo-HSCT，채용배포균소A（CsA）가단정갑안접령（MTX）예방이식물항숙주병（GVHD），부분환자가입매분산지（MMF）。결과27례환자성공획득조혈중건，중성립세포>1.0×109/L화혈소판>20×109/L적중위시간분별위12（10~14）d화13（10~16）d。급성GVHD발생솔위42.3%（11/27），가평고적23례환자중8례발생만성GVHD，균위국한성。이식상관병사솔위22.6%（7례），이식후성공획득완전완해적25례환자중8례혈액학복발，기중3례합병수외복발，복발솔위32%。중위수방23（4~93）개월，지금유14례환자무병생존（DFS），2년DFS위45.4%。결론 allo-HSCT치료진전기난치성AML잉불실위일충유효적만구수단，기중발생만성GVHD적환자예후교호，이이식상관병발증급이식후복발시영향환자생존적주요인소。
Objective To evaluate the efficacy of myeloablative allogeneic hematopietic stem cell transplantation(allo-HSCT)for treatment of refractory acute myeloid leukemia(AML)not in remission. Methods The Results of 31 patients including myeloablative regimen 24 ones using busulfan/cyclophosphamideor and 7 ones receiving total-body irradiation/cyclophosphamide followed by allo-HSCT. Graft versus host disease(GVHD)prophylaxis was CsA plus short term MTX,mycophenolate mofetil (MMF)was also used in some of the patients. Results 27 patients engrafted successfulIy,the median times for their neutrophil>1.0×109/L and platelet>20×109/L were 12(10~14)days and 13(10~16)days after transplantation respectively. The incidence of aGVHD were 42.3%(11/27). Among the 23 evaluable patients,8 experienced local chronic GVHD. The treatment related mortality was 22.6%(7/31),Among the 25 patients who got complete remission after transplantation,8 patients suffered hematologic relapse,and 3 of them also had extramedullary relapse,the relapse rate was 32%.With a median follow-up of 23(4-81)months,14 patients remain alive until now,2 years’ DFS was 45.4%. Conclusion Allo-HSCT is still an effective salvage therapy for refractory AML not in remission. Patients with cGVHD had a better prognosis,transplant-related complications and recurrence are critical for the outcomes of allo-HSCT.