异基因造血干细胞移植治疗急性淋巴细胞白血病25例的临床分析

摘要

Objective To study the effect of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in treatment of patients with acute lymphoblastic leukemia (ALL).Methods A total of 25 patients,including 7 cases with positive Philadelphia chromosome (Ph+) ALL and 18 cases with Ph- ALL,were treated with allo-HSCT in our hospital from March 2009 to August 2015.All cases included 21 cases in complete remission(CR)1,2 cases in CR2,1 cases in partial remission(PR) and 1 cases in un-remission(UR) before allo-HSCT treatment.Seven cases were HLA-identical sibling,three cases were HLA-matched unrelated volunteer and 15 cases were haploidentical sibling.Two patients underwent bone marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT).Conditioning regimen:16 cases received busulfan/cytoxan (Bu/Cy),8 cases received total body irradiation (TBI)/Cy and 1 case received Flu/Bu.Cyclosporine A (CsA),mycophenolate mofetil (MMF),antithymocyte globulin (ATG) and methotrexate (MTX) were used to prevent acute graft versus host disease (aGVHD).Results All patients achieved hematopoietic reconstitution after allo-HSCT.With a follow-up of 12 months,there were 14 cases with disease-free survival (DFS) for 8.5 to 45.0 months after allo-HSCT treatment.Overall survival rate was 60%.The mortality was 40% (10/25) owing to aGVHD,disseminated infection,TA-TMA,relapse and other complications.Conclusion Allo-HSCT is an effective way for the treatment of ALL,and methods that could reduce the relapse and severe complications after allo-HSCT needs further research.%目的 回顾性分析异基因造血干细胞移植(allo-HSCT)治疗急性淋巴细胞白血病(ALL)的疗效.方法 收集2009年3月至2015年8月该院行allo-HSCT的 25例ALL患者,其中费城染色体阳性(Ph+)ALL 7例,Ph－ALL 18例;移植前处于第一次完全缓解(CR1)21例,第二次完全缓解(CR2)2例,第二次复发部分缓解(PR)1例,未缓解(UR)1例.其中同胞全相合7例,无关供者全相合3例,亲缘单倍体15例;2例骨髓移植(BMT)+外周血干细胞移植(PBSCT),23例PBSCT.预处理方案:以白消安/环磷酰胺(Bu/Cy)为主16例,全身照射(TBI)/Cy者8例,氟达拉滨(Flu)/Bu者1例.常规采用环孢菌素A(CsA)、吗替麦考酚酯(MMF)、短程甲氨蝶呤(MTX)+抗胸腺细胞球蛋白(ATG)预防急性移植物抗宿主病(aGVHD).结果 移植后25例患者均获得造血重建,中位随访时间为12月.随访结束有14例无病生存8.5~45.0月,1例移植后复发2次,目前仍在继续随访中;总生存率为60%;有10例(40%)死于aGVHD、感染、移植相关的血栓性微血管病等相关并发症及疾病复发;非复发病死率为24%.结论 allo-HSCT是治疗急性淋巴细胞白血病患者的有效方法,但需进一步探索避免移植后复发及严重并发症的方案.