中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
40期
3185-3188
,共4页
周金懿%何广胜%吴德沛%孙爱宁%仇惠英%金正明%唐晓文%韩悦%傅琤琤
週金懿%何廣勝%吳德沛%孫愛寧%仇惠英%金正明%唐曉文%韓悅%傅琤琤
주금의%하엄성%오덕패%손애저%구혜영%금정명%당효문%한열%부쟁쟁
骨髓增生异常综合征%造血干细胞移植%缓解诱导%预后
骨髓增生異常綜閤徵%造血榦細胞移植%緩解誘導%預後
골수증생이상종합정%조혈간세포이식%완해유도%예후
Myelodysplastic syndromes%Hematopoietic stem cell transplantation%Remission induction%Prognosis
目的 评价异基因造血干细胞移植前诱导治疗对高危组骨髓增生异常综合征(MDS)患者移植预后的影响.方法 收集2002年11月至2012年12月苏州大学附属第一医院接受异基因造血干细胞移植的49例MDS患者的临床资料,按照国际预后评分系统(IPSS)积分、骨髓原始细胞比例等因素进行比较,评估移植前诱导治疗对其生存、复发和移植相关死亡率(TRM)等预后的影响.结果 移植后中位随访时间24.4(6.2～72.0)个月,死亡17例,复发2例.5年总体生存(OS)率、无病生存(DFS)率、复发率和TRM分别为59.9％、59.2％、10.5％和31.8％.高危诱导治疗组(n=17)、高危支持治疗组(n=6)和低危组(n=26)患者间OS、DFS率差异有统计学意义(72.1％比16.7％比68.1％,P=0.028；72.1％比16.7％比67.9％,P=0.030)；而无论诱导治疗是否获得骨髓缓解,高危诱导治疗组的OS、DFS均与低危组相当(P=0.526、0.504),高危诱导治疗组OS、DFS明显优于高危支持治疗组(均P =0.020).高危诱导治疗组中获得缓解者OS、DFS均高于未缓解者(均为100％比46.7％,P=0.049).高危组诱导治疗后骨髓原始细胞负荷明显降低(P=0.010),但累积TRM并未高于支持治疗组(28.9％比33.6％,P=0.612).结论 MDS异基因造血干细胞移植前诱导治疗可降低肿瘤负荷,改善高危组移植后结果,而TRM并未增高.
目的 評價異基因造血榦細胞移植前誘導治療對高危組骨髓增生異常綜閤徵(MDS)患者移植預後的影響.方法 收集2002年11月至2012年12月囌州大學附屬第一醫院接受異基因造血榦細胞移植的49例MDS患者的臨床資料,按照國際預後評分繫統(IPSS)積分、骨髓原始細胞比例等因素進行比較,評估移植前誘導治療對其生存、複髮和移植相關死亡率(TRM)等預後的影響.結果 移植後中位隨訪時間24.4(6.2～72.0)箇月,死亡17例,複髮2例.5年總體生存(OS)率、無病生存(DFS)率、複髮率和TRM分彆為59.9％、59.2％、10.5％和31.8％.高危誘導治療組(n=17)、高危支持治療組(n=6)和低危組(n=26)患者間OS、DFS率差異有統計學意義(72.1％比16.7％比68.1％,P=0.028；72.1％比16.7％比67.9％,P=0.030)；而無論誘導治療是否穫得骨髓緩解,高危誘導治療組的OS、DFS均與低危組相噹(P=0.526、0.504),高危誘導治療組OS、DFS明顯優于高危支持治療組(均P =0.020).高危誘導治療組中穫得緩解者OS、DFS均高于未緩解者(均為100％比46.7％,P=0.049).高危組誘導治療後骨髓原始細胞負荷明顯降低(P=0.010),但纍積TRM併未高于支持治療組(28.9％比33.6％,P=0.612).結論 MDS異基因造血榦細胞移植前誘導治療可降低腫瘤負荷,改善高危組移植後結果,而TRM併未增高.
목적 평개이기인조혈간세포이식전유도치료대고위조골수증생이상종합정(MDS)환자이식예후적영향.방법 수집2002년11월지2012년12월소주대학부속제일의원접수이기인조혈간세포이식적49례MDS환자적림상자료,안조국제예후평분계통(IPSS)적분、골수원시세포비례등인소진행비교,평고이식전유도치료대기생존、복발화이식상관사망솔(TRM)등예후적영향.결과 이식후중위수방시간24.4(6.2～72.0)개월,사망17례,복발2례.5년총체생존(OS)솔、무병생존(DFS)솔、복발솔화TRM분별위59.9％、59.2％、10.5％화31.8％.고위유도치료조(n=17)、고위지지치료조(n=6)화저위조(n=26)환자간OS、DFS솔차이유통계학의의(72.1％비16.7％비68.1％,P=0.028；72.1％비16.7％비67.9％,P=0.030)；이무론유도치료시부획득골수완해,고위유도치료조적OS、DFS균여저위조상당(P=0.526、0.504),고위유도치료조OS、DFS명현우우고위지지치료조(균P =0.020).고위유도치료조중획득완해자OS、DFS균고우미완해자(균위100％비46.7％,P=0.049).고위조유도치료후골수원시세포부하명현강저(P=0.010),단루적TRM병미고우지지치료조(28.9％비33.6％,P=0.612).결론 MDS이기인조혈간세포이식전유도치료가강저종류부하,개선고위조이식후결과,이TRM병미증고.
Objective To explore the impact of prior-to-transplantation induction therapy (IT) on patient outcome after allogeneic hematopoietic stem-cell transplantation (Allo-HSCT) for higher-risk myelodysplastic syndromes (MDS).Methods A total of 49 consecutive patients underwent Allo-HSCT for MDS between November 2002 and December 2012.Twenty-six lower-risk MDS cases received supportive therapy (ST).And 17/23 cases of higher-risk MDS received IT prior to transplantation while anothers 6 only with ST.Their survival,relapse rate and incidence of transplantation-related mortality (TRM) were retrospectively analyzed according to International Prognostic Scoring System (IPSS) scores and marrow blast count.Results The 5-year cumulative overall survival (OS),disease-free survival (DFS),relapse rate and incidence of transplantation related mortality (TRM) were 59.9％,59.2％,10.5％ and 31.8％ during a median follow-up period of 24.4 (6.2-72.0) months.The OS and DFS of higher-risk group with IT,ST and lower-risk group were different (72.1％ vs 16.7％ vs 68.1％,P =0.028; 72.1％ vs 16.7％ vs 67.9％,P =0.030).And the OS and DFS of higher-risk group with IT were similar to those of lower-risk group (P =0.526,0.504).For the higher-risk group,the patients on IT had improved survival than those on ST in terms of OS and DFS (both P =0.020).Moreover,the OS and DFS of remission group were higher than non-remission group in patients on IT (both 100％ vs 46.7％,P =0.049).The number of marrow blasts significantly decreased after IT (P =0.010) without increased TRM (28.9％ vs 33.6％,P =0.612).Conclusion Induction therapy prior to Allo-HSCT for MDS may reduce clone burden and improve the outcomes of higher-risk MDS without increased TRM.
