Efficacy of autologous hematopoietic stem cell transplantation on the treatment of patients with acute myeloid leukemia
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摘要:
目的 观察自体造血干细胞移植对完全缓解期的急性髓系白血病(AML)患者的疗效。 方法 回顾性分析14例行自体造血干细胞移植的AML患者的临床资料,其中低危7例,中危6例,高危1例。预处理后予回输预先冻存的自体外周血造血干细胞,并予成分输血、升白细胞、预防感染等治疗,观察患者的自体干细胞造血重建情况,并了解移植相关并发症的发生情况;绘制生存曲线并计算术后1年和3年的存活率和无病存活(DFS)率。 结果 14例患者均获得造血重建,白细胞植入中位时间为12(9~28)d,血小板植入中位时间为29(8~158)d。2例患者粒细胞缺乏期出现大肠杆菌败血症,1例发生普通变形杆菌败血症,1例患者在移植后29 d出现巨细胞病毒血症,其余患者预处理后出现感染或胃肠道反应,经抗感染及其它对症支持等治疗后均治愈。随访时间29.8(5.3~61.5)个月,14例患者中共有5例复发(35.7%),11例患者存活,3例死于复发。术后1年、3年的存活率分别为86%和79%,术后1年、3年的DFS率分别为64%和57%。 结论 自体造血干细胞移植是大部分低、中危AML患者的有效治疗方法。 -
关键词:
- 急性髓系白血病(AML) /
- 自体造血干细胞移植(auto-HSCT) /
- 微小残留病变(MRD) /
- 造血重建 /
- 外周血造血干细胞 /
- 败血症 /
- 巨细胞病毒血症 /
- 无病存活(DFS)
Abstract:Objective To observe the efficacy of autologous hematopoietic stem cell transplantation on the treatment of patients with acute myeloid leukemia (AML) in complete remission stage. Methods Clinical data of 14 AML patients underwent autologous hematopoietic stem cell transplantation were analyzed retrospectively, including 7 low-risk patients, 6 moderate-risk patients and 1 high-risk patient. After pretreatment, pre-cryopreserved autologous peripheral blood stem cells were retransfused. And component blood transfusion, increasing white blood cell (WBC) count and preventing from infection, etc. were given. Hematopoietic reconstitution of autologous stem cells in the patients was observed, and incidence of transplantation related complications was obtained. Furthermore, survival curves were drawn, and postoperative 1-and 3-year overall survival rates and disease-free survival (DFS) rates were calculated. Results Hematopoietic reconstitution was achieved in all 14 patients. The median time of WBC implantation was 12(9-28) d, and that of platelet implantation was 29(8-158) d. Two patients suffered from E. coli septicemia during neutropenia stage, 1 from proteus vulgaris septicemia, 1 from cytomegalovirus viremia within 29 d after transplantation and the remaining from infection or gastrointestinal reaction after pretreated. All patients were cured by anti-infection and other symptomatic relief and supportive treatment. All patients were followed up for 29.8(5.3-61.5) months. In 14 patients, 5 cases recurred. 11 patients survived and 3 died of recurrence. The postoperative 1-and 3-year overall survival rates were 86% and 79%, and the postoperative 1-and 3-year DFS rates were 64% and 57%. Conclusions Autologous hematopoietic stem cell transplantation is effective in the treatment of majority patients with low-or moderate-risk AML. -
表 1 14例AML患者临床资料
Table 1. Clinical data of 14 patients with AML
例序 性别 年龄(岁) 诊断 初诊白细胞计数
(×109/L)融合基因 危险
分层诊断到移植时间
(月)移植前
MRD1 男 27 M5 15.0 - 中危 7 - 2 女 40 M4Eo 21.0 CBFβ/MYH11 低危 6 - 3 男 53 M2 3.1 AML1/ETO 低危 8 + 4 男 54 M5 29.3 - 中危 7 - 5 男 31 M2 1.9 AML1/ETO 低危 4 - 6 男 16 M5 1.5 - 中危 12 - 7 女 22 髓系肉瘤 4.1 - 中危 9 - 8 女 49 M5 26.4 NPM1 低危 5 + 9 男 15 M2 207.0 CEBPA 高危 5 - 10 男 54 M2 2.1 - 中危 10 + 11 男 17 M4Eo 21.0 CBFβ/MYH11 低危 6 - 12 男 29 M2 35.2 AML1/ETO伴C-KIT 中危 8 - 13 男 33 M2 23.9 AML1/ETO 低危 5 - 14 女 46 M5 2.5 NPM1 低危 6 - 表 2 14例患者auto-HSCT造血重建及预后
Table 2. Hematopoietic reconstruction and prognosis of 14 patients received auto-HSCT
例序 回输单个核细胞
(×108/L)回输CD34+细胞
(×106/L)白细胞
植入时间(d)血小板
植入时间(d)是否复发 复发时间
(月)是否存活 存活时间
(月)1 3.4 3.10 9 14 否 - 是 61.5 2 3.2 0.50 12 34 否 - 是 57.5 3 5.6 1.42 10 12 是 2.8 否 3.9 4 3.7 3.20 9 25 是 6.5 否 7.6 5 3.3 0.60 11 41 否 - 是 42.1 6 3.9 0.36 12 33 否 - 是 37.0 7 5.1 5.04 9 20 否 - 是 32.0 8 3.8 0.60 12 37 否 - 是 27.6 9 3.9 8.60 9 8 是 12.0 是 26.0 10 3.7 0.47 20 120 是 16.0 否 18.2 11 3.0 0.19 16 102 否 - 是 20.5 12 2.1 0.90 12 16 是 5.4 是 14.4 13 4.6 7.26 9 13 否 - 是 9.8 14 7.5 0.07 28 158 否 - 是 5.3 -为无相关数据 -
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