CAJ | 학술논문

目的探讨非血缘脐血移植(UCBT)治疗急性髓系白血病(AML)的疗效及影响疗效的相关因素.方法回顾性分析接受UCBT治疗58例AML患者的临床资料.中位年龄14.5(3～36)岁,中位体重45(12～90) kg.FAB分型:M0l例、M11例、M235例(包括骨髓增生异常综合征转AML l例)、M43例、M514例、M63例、混合细胞白血病1例.移植时处于第1次完全缓解期(CR1)36例,第2次完全缓解期(CR2)14例,未缓解(NR)8例,其中高危难治患者43例(74.1％).单份UCBT 49例(84.5％),双份UCBT9例(15.5％).所有患者均采用强化清髓预处理方案,采用环孢素联合霉酚酸酯预防移植物扰宿主病(GVHD).结果全部58例患者中56例(96.6％)获得造血重建,中性粒细胞植入、血小板植入的中位时间分别为17(12～37)d、33(17～140)d.24例(42.9％)患者发生急性GVHD,其中Ⅱ～Ⅳ度急性GVHD的发生率为30.4％(17/56).在可评估的49例患者中,7例(14.3％)出现慢性GVHD(均为局限型).预期3年累积总体生存(OS)率和无病生存(DFS)率分别为(60.3±6.4)％和(60.1±6.5)％.3年非复发死亡率为33.3％,复发率为9.1％.UCBT时疾病为CR患者(50例)的3年OS率高于NR患者(8例)[(66.0±6.7)％对(25.0±15.3)％,P=0.013].结论 UCBT治疗AML安全有效,慢性GVHD发生率和复发率较低.
목적 탐토비혈연제혈이식(UCBT)치료급성수계백혈병(AML)적료효급영향료효적상관인소.방법 회고성분석접수UCBT치료58례AML환자적림상자료.중위년령14.5(3～36)세,중위체중45(12～90) kg.FAB분형:M0l례、M11례、M235례(포괄골수증생이상종합정전AML l례)、M43례、M514례、M63례、혼합세포백혈병1례.이식시처우제1차완전완해기(CR1)36례,제2차완전완해기(CR2)14례,미완해(NR)8례,기중고위난치환자43례(74.1％).단빈UCBT 49례(84.5％),쌍빈UCBT9례(15.5％).소유환자균채용강화청수예처리방안,채용배포소연합매분산지예방이식물우숙주병(GVHD).결과 전부58례환자중56례(96.6％)획득조혈중건,중성립세포식입、혈소판식입적중위시간분별위17(12～37)d、33(17～140)d.24례(42.9％)환자발생급성GVHD,기중Ⅱ～Ⅳ도급성GVHD적발생솔위30.4％(17/56).재가평고적49례환자중,7례(14.3％)출현만성GVHD(균위국한형).예기3년루적총체생존(OS)솔화무병생존(DFS)솔분별위(60.3±6.4)％화(60.1±6.5)％.3년비복발사망솔위33.3％,복발솔위9.1％.UCBT시질병위CR환자(50례)적3년OS솔고우NR환자(8례)[(66.0±6.7)％대(25.0±15.3)％,P=0.013].결론 UCBT치료AML안전유효,만성GVHD발생솔화복발솔교저.
Objective To evaluate the therapeutic efficacy and related risk factors of acute myelogenous leukemia (AML) patients treated with unrelated cord blood transplantation (UCBT).Methods A retrospective analysis was performed on the clinical data of 58 AML patients that consisted of 1 case of M0,1 case M1,35 cases M2,3 cases M4,14 cases M5,3 cases M6,and 1 case acute mixed leukemia,respectively.Of them,1 case AML secondary to myelodysplastic syndrome,and 36 in first complete remission (CR1),14 in second complele remission (CR2),8 in non-remission (NR),43 cases were refractory or high-risk patients (70.1％).The median age was 14.5 years with the median weight of 45 kg,49 patients received sUCBT and 9 dUCBT.All the patients conditioned with intensified myeloablative regimen and received a combination of Cyclosporine A (CsA) and mycophenolate mofetil (MMF) to prevent graft-versus-host disease (GVHD).Results 56 out of 58 patients achieved engraftment with implantation rate 96.6％.The median time of ANC≥0.5× 109/L was 17(12-37) days,and that of PLT≥20× 109/L 33 (17-140) days respectively.24 cases developed acute GVHD (aGVHD),the incidence rate of grade Ⅱ to Ⅳ aGVHD was 30.4％.The chronic GVHD (cGVHD) was occured in 7 patients of the 49 evaluable patients,all were limited.The estimated 3-year overall survival (OS) and disease-free survival (DFS) were (60.3 ± 6.4) ％ and (60.1 ± 6.5)％ respectively.And the cumulative incidences of 3-year non-relapse mortality (NRM) and relapse were 33.3％ and 9.1％ respectively.The 3-year OS rates of AML patients were (66.0 ± 6.7) ％ for CR and (25.0 ± 15.3)％ for NR,differences were statistical significance.Conclusions For AML patients,UCBT was conducive to improve outcome with lower incidences of cGVHD and relapse,the patients after transplantation could obtain high quality of life.