异基因造血干细胞移植治疗急性淋巴细胞白血病

目的　回顾性分析了急性淋巴细胞白血病 (ALL)异基因造血干细胞移植 (allo HSCT)的疗效及影响疗效的相关因素。方法　 10 0例患者中男 6 9例 ,女 31例 ,中位年龄 2 9.5岁 (4～ 4 7岁 )。移植前处于第 1次完全缓解 (CR1 )者 6 9例 ,复发后多次CR者 13例 ,复发 18例。预处理方案采用全身照射加环磷酰胺 (Cy TBI)方案 4 5例 ,白消安加环磷酰胺 (BUCY)方案 5 5例。移植方式为HLA配型相合的同胞allo HSCT 86例 ,包括骨髓移植 (BMT ) 6 4例 ,外周血造血干细胞移植 (PBSCT) 2 2例 ;HLA配型相合的无血缘关系BMT 8例 ,无血缘关系脐血移植 (CBT) 6例。移植物抗宿主病 (GVHD)预防采用长程甲氨蝶呤 (MTX)方案 4例 ;经典环孢菌素A(CsA)加短程MTX 96例。平均随访时间为 38.1个月。结果　allo HSCT后 5年累积总体生存率 (OS)为 5 3.4 % ,无病生存率 (DFS)为 5 0 .5 %。移植前处于CR1 者 ,5年OS为 70 .5 9% ,DFS为 6 9 8% ,显著高于移植前处于复发后多次CR和复发患者 (P <0 .0 0 1)。同胞BMT与PBSC比较 ,3年OS分别为 5 6 2 %和 6 2 .0 % (P >0 .0 5 ) ,DFS分别为 5 6 .2 %和 5 7.9% (P >0 .0 5 ) ,无显著性差异。多因素分析表明 ,移植前处于CR1 期 ,且缓解时间 >6个月者长期生存率明显提高。比较两种预处理方案患者 5年

Allogeneic hematopoietic stem cell transplantation for acute lymphocytic leukemia

OBJECTIVE: To retrospectively analyze the results of a consecutive series of 100 ALL patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT) in our center. METHODS: Of the 100 ALL patients, 69 were male and 31 female, with a median age of 29.5 (4 - 47) years. Sixty-nine cases were in the first complete remission (CR(1)), 13 in more than CR(1) and 18 in relapse before transplant. Allo-HSCT from HLA identical siblings was performed for 86 patients, of whom 64 received bone marrow transplantation (BMT) and 22 peripheral blood stem cell transplantation (PBSCT). HLA matched unrelated BMT was performed for 8 patients, cord-blood transplantation from unrelated donor for 6 patients. Forty-five patients underwent allo-HSCT with conditioning regimen of Cy/TBI, 55 with BUCY. Prophylaxis of graft-versus-host disease (GVHD) included long-term MTX regimen (4 cases) and CsA + MTX regimen (96 cases). The average follow-up was 38.1 months. RESULTS: The 5-year overall survival (OS) and disease-free survival (DFS) of the 100 cases of ALL was 53.4% and 50.5%. The 5-year OS and DFS were significantly longer for patients in CR(1) than in >CR(1) and relapse patients before allo-HSCT (P < 0.001). The outcome of PBSCT seemed superior to that of BMT, but there was no difference between them. Multivariate analysis showed the most significant factor associated with long post allo-HSCT survival was that the patient underwent transplantation in CR(1). There was no significant difference in 5-year OS, DFS, cumulative incidences of relapse rate and treatment related mortality between the two cohorts prepared with TBI or BUCY. CONCLUSIONS: Allo-HSCT can cure a significant proportion of ALL patients, especially for those in CR(1). There was no significant difference in OS, DFS between the two different conditioning regimens and the different transplant choices.