论文部分内容阅读
目的分析异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,AlloHSCT)治疗高危急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)的疗效,并探讨临床预后因素。方法对我院2007年7月至2013年8月进行Allo-HSCT治疗并随访2年以上的69例ALL患者进行临床分析。按移植方式分为单倍体组(n=42)和全相合组(n=27),对各组患者的临床特征及治疗转归进行回顾性分析,应用Kaplan-Meier法进行生存分析,COX回归模型进行多因素预后分析。结果单倍体组2年总体生存率(overall survival,OS)及2年无白血病生存率(leukemia-free survival,LFS)分别是63.4%、59.4%,而全相合组分别是53.9%、53.7%,两组间差异均无统计学意义(P>0.05);两组间2年累积非复发死亡率(cumulative non-relapse mortality,NRM)差异也无统计学意义(P>0.05);但2年累积复发率(cumulative relapse rate,RR)单倍体组明显高于全相合组(39.5%vs 19.5%,P=0.014)。造血重建方面,单倍体组中性粒细胞植入时间明显晚于全相合移植组(P=0.002),两组血小板植入时间无明显差异(P=0.072)。单倍体组Ⅰ~Ⅱ度急性移植物抗宿主病(graft-versus-host disease,GVHD)发生率明显高于全相合组(P=0.008),两组间Ⅲ~Ⅳ度急性GVHD及慢性GVHD发生率差异无统计学意义(P>0.05)。单倍体组半年内的感染率明显高于全相合组(P=0.02)。COX多因素分析显示患者移植前的疾病状态(非CR1)为异基因移植患者的危险因素(P=0.001),其危险度为7.581;而发生局限性慢性GVHD和初诊距离移植时间较短者为预后保护因素(P=0.013和P=0.012),危险度分别为0.178和0.688。结论在高危组ALL患者的治疗中,单倍体Allo-HSCT与全相合Allo-HSCT的整体疗效相当,因此,单倍体供者可以作为合适的造血干细胞来源。
Objective To analyze the efficacy of allogeneic hematopoietic stem cell transplantation (AlloHSCT) in the treatment of high-risk acute lymphoblastic leukemia (ALL) and to explore the clinical prognostic factors. Methods The clinical data of 69 ALL patients who underwent Allo-HSCT from July 2007 to August 2013 in our hospital and were followed up for more than 2 years were analyzed. The patients were divided into two groups: haploid group (n = 42) and complete matched group (n = 27). The clinical characteristics and treatment outcome of each group were retrospectively analyzed. Survival analysis was performed by Kaplan-Meier method. COX Regression model for multivariate prognostic analysis. Results The 2-year overall survival (OS) and 2-year leukemia-free survival (LFS) of the haploid group were 63.4% and 59.4%, respectively, while that of the haplotype group was 53.9% and 53.7% (P> 0.05). There was also no significant difference in 2-year cumulative non-relapse mortality (NRM) between the two groups (P> 0.05). However, there was no significant difference between the two groups The cumulative relapse rate (RR) in haploid group was significantly higher than that in the all-matched group (39.5% vs 19.5%, P = 0.014). In hematopoietic reconstitution, haploid group neutrophil implantation time was significantly later than that of allograft transplantation group (P = 0.002). There was no significant difference in platelet engraftment time between the two groups (P = 0.072). The incidence of graft-versus-host disease (Ⅰ-Ⅱ) in the haploid group was significantly higher than that in the all-matched group (P = 0.008). The incidence of grade Ⅲ ~ Ⅳ acute GVHD and chronic GVHD The difference was not statistically significant (P> 0.05). The infection rate in haploid group within six months was significantly higher than that in all-matched group (P = 0.02). Cox multivariate analysis showed that the pre-transplant disease status (non-CR1) was a risk factor for allogeneic transplantation (P = 0.001), with a risk of 7.581; whereas, for patients with localized chronic GVHD and those who were initially diagnosed with distance transplants, those with shorter durations were Prognostic factors (P = 0.013 and P = 0.012) were 0.178 and 0.688, respectively. Conclusions The haploidentical Allo-HSCT is equivalent to the fully matched Allo-HSCT in high-risk ALL patients. Therefore, haploidentical donor can be a suitable source of hematopoietic stem cells.