發(fā)布時(shí)間：2019-02-13 10:59

【摘要】：目的:分析異基因造血干細(xì)胞移植(allo-HSCT)治療100例白血病的療效。方法:回顧性分析100例接受allo-HSCT的白血病患者臨床資料,總結(jié)治療效果。在100例患者中急性髓系白血病(AML)47例,急性淋巴細(xì)胞白血病(ALL)33例,急性白血病(混合細(xì)胞型)(HAL)2例,慢性髓系細(xì)胞白血病(CML)16例,慢性粒單核細(xì)胞白血病(CMML)2例。移植前處于第1次完全緩解期(CR1)76例,第2次及以上緩解期9例,未緩解15例。造血干細(xì)胞均來(lái)自外周血。人類白細(xì)胞抗原(HLA)配型全相合移植預(yù)處理多數(shù)采用改良白舒非+環(huán)磷酰胺(Bu Cy)方案,移植物抗宿主病(GVHD)預(yù)防采用經(jīng)典環(huán)孢素A(Cs A)加短療程甲氨蝶呤(MTX)方案;HLA配型不全相合移植預(yù)處理采用氟達(dá)拉濱(Flu)+Bu Cy+抗人胸腺細(xì)胞球蛋白(ATG),GVHD預(yù)防采用Cs A+短療程MTX+嗎替麥考酚酯(MMF)。平均隨訪時(shí)間為13個(gè)月。結(jié)果:至隨訪終點(diǎn),66.0%(66/100)存活,53.0%(53/100)無(wú)病存活,28.0%(28/100)復(fù)發(fā),34.0%(34/100)死亡,其中44.1%死于重癥肺炎。65.0%的患者移植當(dāng)次發(fā)生肺部感染。所有患者移植后的3年總體生存率(OS)為(60.9±5.5)%,3年無(wú)病生存率(DFS)為(48.8±5.6)%。未緩解期移植的復(fù)發(fā)率(66.7%)明顯大于緩解期移植(21.2%)(P0.05)。不全相合移植GVHD的發(fā)生率(60.8%)明顯高于全相合移植(38.8%)(P0.05)。結(jié)論:肺部感染仍是當(dāng)前造血干細(xì)胞移植面臨的一大重要難題。白血病患者應(yīng)在取得CR1后盡早進(jìn)行移植,復(fù)發(fā)病人的移植也應(yīng)爭(zhēng)取在緩解狀態(tài)下進(jìn)行。全相合移植綜合預(yù)后優(yōu)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 鹵5.5)%, and the 3-year disease-free survival rate (DFS) was (48.8 鹵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.
【作者單位】： 南方醫(yī)科大學(xué)珠江醫(yī)院血液科;
【基金】：國(guó)家自然科學(xué)基金項(xiàng)目(81372249) 廣東省產(chǎn)學(xué)研項(xiàng)目(2013B091500072)
【分類號(hào)】：R457.7;R733.7

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