论文部分内容阅读
本研究探索难治复发性急性髓系白血病(AML)患者的缓解状态对异基因造血干细胞移植(allo-HSCT)预后的影响。对32例接受allo-HSCT的难治复发性AML的治疗结果进行回顾性分析,其中移植前未缓解(NR)17例,完全缓解(CR)15例,比较两组在治疗相关不良反应、白血病复发和无白血病生存率(LFS)等方面的差异。结果表明,两组病例在性别、年龄、细胞遗传学特征和移植方式等方面均具有可比性。除NR组中1例移植失败,1例死于重症肝静脉阻塞病以外,其余30例均获得造血重建。NR组与CR组aGVHD发生率分别为47.1%(8例)和33.3%(5例)。在可评估的患者中,NR组9例中5例发生cGVHD,CR组11例中4例发生cGVHD,两组发生aGVHD(P=0.335)和cGVHD(P=0.217)的差异均无统计学意义。NR组治疗相关死亡率(29.4%vs 14.3%,P=0.392)及移植后复发率(42.9%vs 26.7%,P=0.300)较CR组高,但差异均无统计学意义。中位随访13(1-124)个月,至今NR组和CR组各有6例无病生存,2年LFS两组相近(35.3%vs 40.0%,P=0.267)。对32例患者的单因素生存分析结果显示,年龄<35岁(P=0.044)及发生cGVHD(P=0.046)的患者总生存率(OS)显著延长。结论:单中心样本研究结果显示,allo-HSCT是挽救性治疗难治复发性AML的有效手段,移植前NR的患者预后与CR患者相比,allo-HSCT疗效及预后无显著性差异,提示对NR状态的难治复发性AML患者实施allo-HSCT,并通过移植后过继免疫治疗产生cGVHD,以期获得长期生存是可行的。
This study explored the impact of remission status in patients with refractory recurrent acute myeloid leukemia (AML) on the prognosis of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Thirty-two unresectable AML patients who underwent allo-HSCT were retrospectively analyzed. Among them, 17 were untreated (NR) and 15 were completely relieved (CR) before transplantation. The treatment-related adverse reactions, leukemia Recurrence and non-leukemia survival rate (LFS) and other differences. The results showed that the two groups of patients in gender, age, cytogenetic characteristics and transplantation methods are comparable. One patient in NR group failed to transplant and one patient died of severe hepatic vein occlusion, while the remaining 30 patients received hematopoietic reconstitution. The incidence of aGVHD was 47.1% (8 cases) and 33.3% (5 cases) in NR group and CR group respectively. Among the evaluable patients, cGVHD occurred in 5 of 9 patients in NR group and 4 patients of CRG group (n = 4). There was no significant difference between the two groups in aGVHD (P = 0.335) and cGVHD (P = 0.217) . The treatment-related mortality (29.4% vs 14.3%, P = 0.392) and the post-transplant recurrence rate (42.9% vs 26.7%, P = 0.300) in the NR group were higher than those in the CR group, but the differences were not statistically significant. At a median follow-up of 13 (1-124) months, there were 6 disease-free survivals in each of the NR and CR groups, with a similar incidence of 2-year LFS (35.3% vs 40.0%, P = 0.267). The univariate survival analysis of 32 patients showed a significantly longer overall survival (OS) for patients aged <35 years (P = 0.044) and those with cGVHD (P = 0.046). Conclusion: Allo-HSCT is an effective method for salvage therapy of refractory recurrent AML. Prognosis of patients with pre-transplant NR has no significant difference in the efficacy and prognosis of allo-HSCT compared with CR patients, Allo-HSCT is performed in refractory relapsed AML patients with NR status and cGVHD through adoptive immunotherapy after transplantation in order to obtain long-term survival is feasible.