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目的探讨异基因造血干细胞移植治疗急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)的近期疗效及远期预后分析。方法选取2008年9月—2011年12月白求恩国际和平医院进行异基因造血干细胞移植治疗的急性淋巴细胞白血病患者56例,分析其移植后的近期疗效与远期疗效,通过COX回归模型探讨影响患者预后复发的危险因素。结果56例患者骨髓移植后17 d后TRM为3.5%(2/56);96.4%(54/56)的患者NE细胞植入成功;4例患者血小板植入未成功;植入30 d后49例患者骨髓嵌合率为100%,其他3例患者骨髓嵌合率分别为74.2%、49.6%、58.7%;随访期间12.5%(7/56)的患者出现慢性移植物抗宿主病情况;20例患者出现急性移植物抗宿主病(acute graft-versus-host disease,a GVHD),其中发生多器官a GVHD患者5例;进行移植后3个月内8.9%(5/56)出现死亡,复发率为8.9%(12/56)。3年总生存率为64.7%,无病生存率为61.4%;影响ALL患者移植远期预后复发单因素可能与供体类型、移植前疾病状态、伴髓系表达、预处理剂量和移植方式有关(P<0.05);经COX分析结果显示非相关供体、移植前非CR状态、标准预处理剂量为影响ALL患者移植远期预后复发的危险因素(P<0.05)。结论异基因造血干细胞移植治疗ALL患者近期疗效佳且死亡率低,但复发率高。存在非相关供体、移植前非CR状态、标准预处理剂量的ALL患者远期预后复发危险性高。
Objective To investigate the short-term efficacy and long-term prognosis of allogeneic hematopoietic stem cell transplantation in the treatment of acute lymphoblastic leukemia (ALL). Methods Fifty-six patients with acute lymphoblastic leukemia treated with allogeneic hematopoietic stem cell transplantation were selected from September 2008 to December 2011 in Bethune International Peace Hospital. The short-term and long-term effects were evaluated after COX regression analysis. Prognosis of the risk factors for recurrence. Results The TRM was 3.5% (2/56) in 17 patients after BMT in 56 patients. The number of NE cells in 96.4% (54/56) patients was successfully implanted. The platelet transplants in 4 patients were unsuccessful. The chimerism rate was 100% in the patients and 74.2%, 49.6% and 58.7% in the other three patients, respectively. Chronic graft-versus-host disease was found in 12.5% (7/56) of the patients during the follow-up period. 20 The patients had acute graft-versus-host disease (aGVHD), in which 5 patients had multi-organ a GVHD; 8.9% (5/56) died and relapsed within 3 months after transplantation The rate was 8.9% (12/56). The 3-year overall survival rate was 64.7% and the disease-free survival rate was 61.4%. The single factor influencing long-term prognosis of ALL patients may be related to donor type, pre-transplant disease status, myeloid lineage, pretreatment dose and transplantation mode (P <0.05). The results of COX analysis showed that non-related donors, pre-transplant non-CR status and standard pretreatment dose were the risk factors influencing the long-term recurrence of ALL patients (P <0.05). Conclusion Allogeneic hematopoietic stem cell transplantation for the treatment of ALL patients with good short-term efficacy and mortality, but the recurrence rate. Non-related donors, pre-transplant non-CR status, standard pretreatment dose of ALL patients with long-term prognosis of high risk of recurrence.