两种异基因造血干细胞移植治疗白血病的临床观察

目的 比较HLA单倍型供者造血干细胞移植(HLA-haploidentical RD-HSCT)和非血缘供者造血干细胞移植(URD-HSCT)治疗白血病的疗效.方法 分析93例接受异基因造血干细胞移植(allo-HSCT)白血病患者的资料,其中51例患者接受HLA-haploidentical RD-HSCT,42例接受URD-HSCT.HLA-haploidentical RD-HSCT组中42例患者予氟达拉滨(Flu)+白消安(Bu)+阿糖胞苷(Ara-C)预处理方案,9例予全身照射(TBI) +Flu+Ara-C预处理方案;URD-HSCT组患者中35例接受改良白消安/环磷酰胺(Bu/Cy)方案预处理,7例予TBI+Flu方案.结果 HLA-haploidentical RD-HSCT和URD-HSCT组中性粒细胞数＞ 0.5×109/L时间分别为移植后12.5 d(11 ～17d)和16.2 d(12～21 d),血小板计数＞20× 109/L时间分别为移植后17.5 d(16～25 d)和20.3 d(17～28 d),两组中性粒细胞和血小板重建时间差异均有统计学意义(P值分别为0.008、0.023).HLA-haploidentical RD-HSCT组与URD-HSCT组2～4度急性移植物抗宿主病(GVHD)发生率分别为46.0％(23/50)和51.2 ％(21/41),慢性GVHD总发生率分别为46.0％(23/50)和63.4％(26/41),GVHD致死率分别为6.0％(3/50)和17.1％(7/41),差异均无统计学意义(P值分别为0.773、0.529、0.113).两组移植后复发率分别为17.6％(9/51)和11.9％(5/42)(P=0.653).3年总生存率分别为(56.3±7.0)％和(63.1±5.8)％(P=0.318),无病生存率分别为(48.2±7.7)％和(62.3±9.4)％(P=0.661).结论 采用加强预处理及免疫抑制剂的HLA-haploidentical RD-HSCT治疗白血病,在不增加感染和GVHD发生率的基础上,可取得与URD-HSCT近似的疗效.

Clinical observation of HLA-haploidentical related or unrelated donors allogeneic hematopoietic stem cell transplantation for leukemia

Objective To compare the effects of HLA-haploidentical related donors (RD) and unrelated donors (URD) hematopoietic stem cell transplantations (HSCTs) for leukemia.Methods Ninety-three leukemia patients who underwent allogenic HSCT were divided into two groups including 51 cases of HLA-haploidentical RD-HSCT and 42 cases of URD-HSCT.In the RD-HSCT group, a preconditioning regimen with fludarabine (Flu)+busulfan (Bu)+cytosine arabinoside (Ara-C) was employed for 42 cases and total body irradiation (TBI)+Flu+Ara-C for the rest of the 9 cases.In the URD-HSCT group, the modified preconditioning regimen with Bu+cyclophosphamide (Cy) was employed in 35 cases, while the other 7 cases underwent the treatment of TBI+Flu.Results After transplantation, the mean time of reaching the neutrophil count of more than 0.5×109/L was 12.5 and 16.2 days, while the mean time of attaining platelet count of more than 20×109/L was 17.5 and 20.3 days in the RD-and URD-HSCT groups, respectively.The occurrence rates of grade Ⅱ-Ⅳ acute graft-versus-host disease (aGVHD) were 46.0 ％ (23/50) and 51.2 ％ (21/41) in the RD-and URD-HSCT groups, respectively, and the rates of chronic GVHD (cGVHD) were 46.0 ％ (23/50) and 63.4 ％ (26/41), respectively.Furthermore, the mortality rates of GVHD were 6.0 ％ (3/50) and 17.1％ (7/41) in the RD-and URD-HSCT groups, respectively.No significant difference in the occurrence of aGVHD (P =0.773), cGVHD (P =0.529) and mortality of GVHD (P =0.113) was detected between the two groups.The recurrence rate after transplantation, three-year survival rate and disease-free survival rate were 17.6 ％, (56.3±7.0) ％ and (63.1±5.8) ％ in HLA-haploidentical RD-HSCT group, and 11.9 ％, (48.2±7.7) ％ and (62.3±9.4) ％ in URD-HSCT group, respectively.There were no significant differences between the two groups (P =0.653, P =0.318 and P =0.661).Conclusion HLA-haploidentical RD-HSCT with enhanced preconditioning and administration of immunosuppressants shows the similar clinical efficacy to URD-HSCT in the battle against leukemia, without the risk of increasing infection and GVHD incidence.