中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2017, Vol. 46 ›› Issue (1): 45-49.doi: 10.12007/j.issn.0258-4646.2017.01.010

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异基因造血干细胞移植治疗急性髓系白血病以及骨髓增生异常综合征

蔡大利,高峰,高然,苏楠,马凤宇,莫文斌,李艳   

  1. 中国医科大学附属第一医院血液科,沈阳 110001
  • 收稿日期:2016-06-29 出版日期:2017-01-28 发布日期:2017-01-10
  • 通讯作者: 李艳 E-mail:liyan2@medmail.com.cn
  • 作者简介:蔡大利(1965 -),男,副主任医师,博士 .

Analysis of Allogeneic Hematopoietic Stem Cell Transplantation for Patients with Acute Myeloid Leukemia and Myelodysplastic Syndrome

CAI Dali,GAO Feng,GAO Ran,SU Nan,MA Fengyu,MO Wenbin,LI Yan   

  1. Department of Hematology,The First Hospital,China Medical University,Shenyang 110001,China
  • Received:2016-06-29 Online:2017-01-28 Published:2017-01-10

摘要: 目的 观察异基因造血干细胞移植治疗急性髓系白血病以及骨髓增生异常综合征的疗效和安全性。方法 回顾性分 析 2011 年 4 月至 2016 年 4 月在我院接受了异体造血干细胞移植的 21 例急性髓系白血病和 8 例骨髓增生异常综合征病例。其 中,人类白细胞抗原(HLA)全相合异基因移植 16 例,单倍体相合异基因移植 10 例,同基因移植 3 例。预处理方案采用 BuCy2± 化疗,或全身照射(TBI)7.5~10 Gy 联合环磷酰胺 120 mg/kg±化疗。HLA 全相合移植应用环孢素联合短程甲氨喋呤预防移植物 抗宿主病(GVHD),单倍体相合移植采用兔抗人胸腺细胞球蛋白+环孢素+骁悉+甲氨喋呤+糖皮质激素,同基因移植无需 GVHD 预防。结果 所有患者获得供者型造血重建。移植后 100 d 内死亡 2 例,随访中位时间 23 个月(1~60 个月)。Ⅱ~Ⅳ度急性 GVHD 发生率为 23.1%(6/26),其中Ⅲ/Ⅳ度 2 例;慢性 GVHD 50%,其中轻度 cGVHD 3 例,中度 6 例,重度 4 例。移植相关死亡率13.8%(4/29),复发死亡率 20.7%(6/29),2 年总体生存率 68.09%(95%CI:45.77%~82.78%),无病生存率 60.22 %(95%CI:38.19%~76.55%)。生存分析显示高危患者仍存在较高复发风险。结论 HLA 全相合及单倍体相合异基因造血干细胞移植是安全、有效、可行的。严密监测高危患者,提前或及早干预是必要的,有利于进一步提高移植疗效。

关键词: 造血干细胞移植, 急性髓系白血病, 骨髓增生异常综合征, 移植物抗宿主病

Abstract: Objective To evaluate the efficacy and safety of HLA identical and haploidentical related allogeneic hematopoietic stem cell transplantation in the treatment of acute myeloid leukemia(AML)and myelodysplastic syndrome(MDS). Methods A total of 21 patients with AML and 8 patients with MDS who underwent allogeneic hematopoietic stem cell transplantation in our hospital from April 2011 to April 2016 were analyzed retrospectively,including 16 cases of HLA-identical allogeneic HSCT,10 cases of haploidentical allogeneic HSCT,and 3 cases of syngeneic HSCT. BUCY2 or TBI plus CY ± chemotherapeutic agents was the regular conditioning regimen. No graft versus host disease(GVHD)prophylaxis was required for syngeneic HSCT,but cyclosporine in combination with methotraxate was essential for allogeneic HSCT,cyclosporine,methotraxate,antithymocyte globulin,mycophenolate mofetil and glucosteroids for haploidentical HSCT. Results All patients achieved fully donor-originated hematopoiesis. Two patients died of severe acute GVHD within 100 days post HSCT. Acute GVHD with grade Ⅱ-Ⅳ occurred in 23.1%(6/26) patients,chronic GVHD in 50% patients,therapy and relapse-relevant mortality was 4/29(13.8%)and 6/29(20.7%)cases within a median follow- up of 23(1-60)months,respectively. Two-year overall survival and leukemia free survival rates are 68.09%( 95%CI:45.77%-82.78%)and 60.22 %(95% CI:38.19% - 76.55%),respectively. High risk AML is still the main challenge to longterm leukemia free survival. Conclusion HLA identical and haploidentical allogeneic HSCT for AML and MDS is safe,effective and feasible. Minimal residual disease monitoring and preventative as well as preemptive intervention is necessary for improving prognosis of high risk AML.

Key words: hematopoietic stem cell transplantation, acute myeloid leukemia, myelodysplastic syndrome, graft versus host disease

中图分类号: 

  • R557
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[5] 蔡大利,高峰,高然,李艳. 异基因外周血造血干细胞联合骨髓移植治疗重型再生障碍性贫血:4例报告[J]. 中国医科大学学报, 2013, 42(4): 379-382.
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