中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2015年
2期
82-86
,共5页
李桥川%章忠明%刘练金%周贻振%赖永榕
李橋川%章忠明%劉練金%週貽振%賴永榕
리교천%장충명%류련금%주이진%뢰영용
白血病,淋巴细胞,急性%造血干细胞移植
白血病,淋巴細胞,急性%造血榦細胞移植
백혈병,림파세포,급성%조혈간세포이식
Leukemia,lymphoblastic,acute%Hematopoietie stem cell transplantation
目的 探讨异基因外周血造血干细胞移植(allo-PBSCT)治疗急性淋巴细胞白血病(ALL)的疗效.方法 2002年2月至2014年2月采用HLA相合allo-PBSCT治疗ALL 95例.采用全身照射(TBI)+环磷酰胺(Cy)或白消安+ Cy为主的预处理方案.同胞供者68例,非血缘供者27例.存活受者的中位随访期为57个月(4~148个月).结果 95例受者均造血功能完全重建,中性粒细胞和血小板植活时间中位数分别为移植后12 d(9~22 d)和16 d(9~39 d).Ⅱ~Ⅳ度急性移植物抗宿主病(aGVHD)累积发生率为19.4%,慢性移植物抗宿主病(cGVHD)累积发生率为43.3%.累积白血病复发率为30.2%,累积移植相关死亡率为24.0%.5年预期总体存活率(OS)及无白血病复发存活率(DFS)分别为54.3%和51.2%,其中第1次完全缓解(CR1)期接受移植者移植后5年预期OS和DFS分别为65.5%和64.0%.无白血病复发存活时间超过1年的59例受者中,发生cGVHD者的OS和DFS显著低于未发生cGVHD者(P<0.05).多因素分析显示,与白血病复发相关的危险因素是移植前处于白血病复发后多次CR(CR2)、移植前未缓解(NR)和未采用TBI方案,与移植相关死亡的危险因素是发生Ⅱ~Ⅳ度aGVHD和cGVHD,移植前NR和发生Ⅱ~Ⅳ度aGVHD是影响OS的独立危险因素,CR2期接受移植、NR期接受移植和发生Ⅱ~Ⅳ度aGVHD是影响DFS的独立危险因素.结论 Allo-PBSCT是治疗ALL的有效方法,如有HLA相合供者,Allo-PBSCT可作为成人ALL患者的治疗首选在CR1期进行;预防发生严重aGVHD和cGVHD有可能进一步提高HLA相合allo-PBSCT的疗效.
目的 探討異基因外週血造血榦細胞移植(allo-PBSCT)治療急性淋巴細胞白血病(ALL)的療效.方法 2002年2月至2014年2月採用HLA相閤allo-PBSCT治療ALL 95例.採用全身照射(TBI)+環燐酰胺(Cy)或白消安+ Cy為主的預處理方案.同胞供者68例,非血緣供者27例.存活受者的中位隨訪期為57箇月(4~148箇月).結果 95例受者均造血功能完全重建,中性粒細胞和血小闆植活時間中位數分彆為移植後12 d(9~22 d)和16 d(9~39 d).Ⅱ~Ⅳ度急性移植物抗宿主病(aGVHD)纍積髮生率為19.4%,慢性移植物抗宿主病(cGVHD)纍積髮生率為43.3%.纍積白血病複髮率為30.2%,纍積移植相關死亡率為24.0%.5年預期總體存活率(OS)及無白血病複髮存活率(DFS)分彆為54.3%和51.2%,其中第1次完全緩解(CR1)期接受移植者移植後5年預期OS和DFS分彆為65.5%和64.0%.無白血病複髮存活時間超過1年的59例受者中,髮生cGVHD者的OS和DFS顯著低于未髮生cGVHD者(P<0.05).多因素分析顯示,與白血病複髮相關的危險因素是移植前處于白血病複髮後多次CR(CR2)、移植前未緩解(NR)和未採用TBI方案,與移植相關死亡的危險因素是髮生Ⅱ~Ⅳ度aGVHD和cGVHD,移植前NR和髮生Ⅱ~Ⅳ度aGVHD是影響OS的獨立危險因素,CR2期接受移植、NR期接受移植和髮生Ⅱ~Ⅳ度aGVHD是影響DFS的獨立危險因素.結論 Allo-PBSCT是治療ALL的有效方法,如有HLA相閤供者,Allo-PBSCT可作為成人ALL患者的治療首選在CR1期進行;預防髮生嚴重aGVHD和cGVHD有可能進一步提高HLA相閤allo-PBSCT的療效.
목적 탐토이기인외주혈조혈간세포이식(allo-PBSCT)치료급성림파세포백혈병(ALL)적료효.방법 2002년2월지2014년2월채용HLA상합allo-PBSCT치료ALL 95례.채용전신조사(TBI)+배린선알(Cy)혹백소안+ Cy위주적예처리방안.동포공자68례,비혈연공자27례.존활수자적중위수방기위57개월(4~148개월).결과 95례수자균조혈공능완전중건,중성립세포화혈소판식활시간중위수분별위이식후12 d(9~22 d)화16 d(9~39 d).Ⅱ~Ⅳ도급성이식물항숙주병(aGVHD)루적발생솔위19.4%,만성이식물항숙주병(cGVHD)루적발생솔위43.3%.루적백혈병복발솔위30.2%,루적이식상관사망솔위24.0%.5년예기총체존활솔(OS)급무백혈병복발존활솔(DFS)분별위54.3%화51.2%,기중제1차완전완해(CR1)기접수이식자이식후5년예기OS화DFS분별위65.5%화64.0%.무백혈병복발존활시간초과1년적59례수자중,발생cGVHD자적OS화DFS현저저우미발생cGVHD자(P<0.05).다인소분석현시,여백혈병복발상관적위험인소시이식전처우백혈병복발후다차CR(CR2)、이식전미완해(NR)화미채용TBI방안,여이식상관사망적위험인소시발생Ⅱ~Ⅳ도aGVHD화cGVHD,이식전NR화발생Ⅱ~Ⅳ도aGVHD시영향OS적독립위험인소,CR2기접수이식、NR기접수이식화발생Ⅱ~Ⅳ도aGVHD시영향DFS적독립위험인소.결론 Allo-PBSCT시치료ALL적유효방법,여유HLA상합공자,Allo-PBSCT가작위성인ALL환자적치료수선재CR1기진행;예방발생엄중aGVHD화cGVHD유가능진일보제고HLA상합allo-PBSCT적료효.
Objective To analyze the outcomes and the prognostic factors of allogeneic peripheral blood stem cell transplantation (allo-PBSCT) for acute lymphoblastic leukemia (ALL).Method From Feb.2002 to Feb.2014,a total of 95 patients with ALL were treated with alloPBSCT in our hospital.Of these,73 cases obtained the first CR (CR1),11 cases obtained late CR,7 patients were in relapse and 3 patients suffered from primarily refractory disease (PRD) before transplant.The median age was 26 (4-57) years.Conditioning regimens including total body irradiation (TBI)/ etoposide/semustine/cyclophosphamide or busulfan/semustine/cyclophosphamide were used.Matched sibling transplantation was performed on 68 patients,and matched unrelated donor transplantation was performed on 27 patients.Combination of CsA,MTX and low-dose,short-course mycophenolate mofetil was used for graft-versus-host disease (GVHD) prophylaxis.The average fellow-up was 57 months.Result Hematopoietic reconstitution was achieved in all 95 patients.Five-year estimate of overall survival (OS) was 54.3%,disease free survival (DFS) was 51.2%,relapse rate (RR) was 30.2% and transplant-related mortality (TRM) was 24.0%.The 5 year OS and DFS were significantly longer in patients with CR1 than in late CR and relapse/PRD patients before allo-PBSCT (P<0.001).There was no significant difference in OS between the two different conditioning regimens.Multivariate analyses revealed that Ⅱ-Ⅳ aGVHD and cGVHD were correlated with higher TRM,CR1 before allo-PBSCT and TBI were associated with a lower RR,and non Ⅱ-Ⅳ aGVHD and CR1 before allo-PBSCT were favorable factors which were associated with OS and DFS.In the patients with DFS≥1 year after allo-PBSCT,DFS and OS were shorter in patients with cGVHD (P =0.008).Conclusion Allo-PBSCT in adult ALL patients should be performed in CR1.Severe acute and chronic GVHD are not associated with improved survival.