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目的:探讨以FABC预处理进行同胞异基因造血干细胞移植治疗成人高危急性淋巴细胞白血病(ALL)的疗效及相关临床预后因素。方法:2004年8月至2010年8月期间,广东省人民医院采用FABC预处理方案(氟达拉滨联合阿糖胞苷,马法兰,环磷酰胺,足叶乙甙或替尼泊甙)治疗23例成人高危ALL患者,应用Kaplan-Meier法及Cox回归模型进行生存及预后分析。结果:所有患者均于+14～+21d获完全供者植入,骨髓获CR或CRi,中性粒细胞和血小板植活中位时间分别为12(4～43)d和12(5～44)d;aGVHD及cGVHD累积发生率分别为47.8%和84.2%。中位随访21(4.4～70.5)个月,移植相关死亡率为21.7%(5/23),复发率为17.4%(4/23);死亡(8/23)原因:复发3例,肺部真菌感染2例,移植相关性微血管病、巨细胞病毒肺炎和cGVHD各1例。3年的预期总生存率和无病生存率(DFS)分别是(54.4±14.6)%和(51.9±14.1)%。预后分析显示:cGVHD是DFS独立有利因素,其相对危险度为0.062(95%可信区间0.007～0.584,P=0.015)。结论:FABC预处理同胞异基因造血干细胞移植是治疗成人高危ALL安全有效的方法,cGVHD是长期无病生存的独立有利因素。
Objective: To investigate the efficacy and related prognostic factors of FABC pretreatment for allogeneic hematopoietic stem cell transplantation in adults with high-risk acute lymphoblastic leukemia (ALL). Methods: From August 2004 to August 2010, Guangdong Provincial People’s Hospital adopted FABC pretreatment regimen (fludarabine combined with cytarabine, melphalan, cyclophosphamide, etoposide or teniposide) Twenty-three adult high risk ALL patients were analyzed for survival and prognosis using Kaplan-Meier method and Cox regression model. RESULTS: All patients received complete donor implantation at +14 to +21 days with bone marrow CR or CRi, median neutrophil and platelet activation time 12 (4 to 43) d and 12 (5 to 44 ) d. The cumulative incidences of aGVHD and cGVHD were 47.8% and 84.2%, respectively. The median follow-up of 21 (4.4 to 70.5) months was 21.7% (5/23) with a relapse rate of 17.4% (4/23). The cause of death (8/23) 2 cases of fungal infection, transplantation-related microangiopathy, cytomegalovirus pneumonia and 1 case of cGVHD. The expected 3-year overall and disease-free survival (DFS) were (54.4 ± 14.6)% and (51.9 ± 14.1)%, respectively. Prognostic analysis showed that cGVHD was an independent predictor of DFS with a relative risk of 0.062 (95% confidence interval 0.007 to 0.584, P = 0.015). CONCLUSION: FABC-preconditioned sibling allogeneic hematopoietic stem cell transplantation is a safe and effective method for the treatment of adult high-risk ALL. CGVHD is an independent and favorable factor for long-term disease-free survival.