论文部分内容阅读
目的比较联合化疗和自体造血干细胞移植(ASCT)在成人急性淋巴细胞白血病(ALL)缓解后治疗的疗效。方法对我院移植中心1990年7月至2003年12月首次诱导缓解、早期连续强化巩固治疗4个疗程后接受ASCT或联合化疗的74例成人ALL患者的疗效进行回顾性分析。联合化疗患者40例,ASCT患者34例,中位随访时间20.5个月,比较两组患者累积无白血病生存(LFS)率、总生存(OS)率及累积复发率。结果①化疗组患者中位LFS和OS期分别是14.0和20.6个月,而ASCT组中位LFS和OS期均大于53.5个月;②化疗组患者28例(70%)复发,而ASCT组患者移植后11例(32.35%)复发;③ASCT组患者1年LFS、OS率及复发率与化疗组患者相比差异无统计学意义(P值均>0.05),而3年及5年预期LFS和OS率明显高于化疗组(P值均<0.05),ASCT组患者的3年及5年复发率显著低于化疗组(P<0.05);④ASCT前移植物体外净化和移植后维持治疗(处理组)患者3年以上LFS和OS率高于未处理组患者(P<0.05),累积复发率低于未处理组患者(P<0.05)。结论ASCT可以有效降低成人ALL患者在早期连续强化巩固治疗后的远期复发率;ASCT前体外净化和移植后维持治疗可降低复发率,提高长期生存率。
Objective To compare the effects of combined chemotherapy and autologous hematopoietic stem cell transplantation (ASCT) in the treatment of adult acute lymphoblastic leukemia (ALL). Methods Retrospective analysis was performed on the efficacy of 74 adult ALL patients receiving ASCT or combined chemotherapy after first course of remission and early continuous consolidation and consolidation therapy in our hospital from July 1990 to December 2003. 40 patients with combined chemotherapy, 34 patients with ASCT, the median follow-up time was 20.5 months. There was no cumulative leukemia survival (LFS), overall survival (OS) and cumulative recurrence in the two groups. Results The median LFS and OS of patients in chemotherapy group were 14.0 and 20.6 months respectively, while the median LFS and OS of ASCT group were both longer than 53.5 months. In the chemotherapy group, 28 patients (70%) relapsed while those in ASCT group There was no significant difference in the 1-year LFS, OS rates and recurrence rates between ASCT patients and chemotherapy patients (P> 0.05), while the 3-year and 5-year expected LFS and OS rates (P <0.05). The 3-year and 5-year recurrence rates of patients with ASCT were significantly lower than those of chemotherapy group (P <0.05). ④ The ASCT anterior grafts were purified in vitro and maintained after transplantation (P <0.05). The cumulative recurrence rate was lower than that of the untreated group (P <0.05). Conclusion ASCT can effectively reduce the long-term relapse rate of adult patients with ALL after early consolidation and consolidation therapy. Ex vivo purification and post-transplant maintenance therapy can reduce the recurrence rate and improve the long-term survival rate.