中国组织工程研究2017，Vol.21Issue(9)：1450-1455,6.DOI:10.3969/j.issn.2095-4344.2017.09.025
异基因造血干细胞移植治疗染色体核型预后中等急性髓系白血病
Allogeneic hematopoietic stem cell transplantation for intermediate cytogenetic risk acute myeloid leukemia
摘要
Abstract
BACKGROUND: Previous studies have shown that HLA-identical sibling allogeneic peripheral blood hematopoietic stemcelltransplantation (allo-HSCT) provides higher disease-free and overall survival rates for patients with intermediatecytogenetic risk acute myeloid leukemia (AML) in complete remission (CR). But prognosis factors have not been fullydefined.OBJECTIVE: To evaluate the outcome of patients with intermediate cytogenetic risk AML undergoing HLA-matchedallo-HSCT in CR, and to analyze the prognostic factors.METHODS: Fifty cases of intermediate cytogenetic risk AML in CR receiving HLA-matched allo-HSCT from January2009 to January 2015 were retrospectively analyzed. Primary outcome measures of the study included overall survival(OS), relapse rate and non-relapse mortality.RESULTS AND CONCLUSION: The 4-year OS of the study population reached to 64%, and the relapse rate and NRMreached to 18% and 20% respectively. Incidence of acute graft-versus-host disease was 26%. Different prognosis wasobserved between female donor/male recipient (FDMR) combination transplant and control (4-year OS: 50% vs. 71.9%,P=0.041), between patients requiring more than one course of induction chemotherapy to achieve CR and control(4-year OS: 40% vs. 70%, P=0.038), between older age (≥ 40 years) and control (4-year OS: 44.4% vs. 68.3%,P=0.056). The 4-year OS for matched sibling donor and matched unrelated donor was 63.2% and 66.7% (P=0.427),respectively. Further analysis revealed significantly high non-relapse mortality in FDMR combination transplant (P=0.024)and older age (≥ 40 years; P=0.043). Multivariate analysis revealed three negative prognostic factors: FDMRcombination (P=0.031, RR=1.38, 95% CI: 1.03-1.95), requiring more than one course of induction chemotherapy toachieve CR (P=0.016, RR=1.46, 95% CI: 1.10-1.98) and older age (≥ 40 years; P=0.024, RR=1.63, 95% CI: 1.32-2.12).To conclude, HLA-matched allo-HSCT is a choice for the intermediate cytogenetic risk AML case in CR. FDMRcombination, requiring more than one course of induction chemotherapy to achieve CR and older age (≥ 40 years) areconfirmed as risk factors of poor prognosis for HLA-matched allo-HSCT patients with intermediate cytogenetic risk AMLin CR. To these cases, the donor-recipient sex combination is more important than the donor type in donor selection.关键词
干细胞/移植/白血病/急性髓系白血病/染色体核型预后中等/HLA相合异基因造血干细胞移植/国家自然科学基金分类
医药卫生引用本文复制引用
张文荟,迟凯凯,陈玉清,杨靖,朱尊民,孙恺,张茵..异基因造血干细胞移植治疗染色体核型预后中等急性髓系白血病[J].中国组织工程研究,2017,21(9):1450-1455,6.基金项目
国家自然科学基金面上项目(81273259),项目名称:受者"Unlicensed"Ly49+NK 细胞亚群在特异性调节异基因移植排斥反应中的作用及机制 the National Natural Science Foundation of China, No. 81273259 （81273259）
