白血病患者异基因造血干细胞移植后复发的高危因素分析

目的 分别统计分析急性淋巴细胞白血病(ALL)、急性髓系白血病(AML)和慢性髓系白血病(CML)患者行异基因造血干细胞移植(allo-HSCT)后复发的高危因素,比较各高危因素的影响并初步分析其影响机制.方法 单中心回顾性研究,以近8年来接受allo-HSCT的262例可评价的白血病患者为研究对象,其中ALL 69例,AML(除外急性早幼粒细胞白血病)90例,CML 103例,采用COX比例风险模型对移植前多项指标进行单因素及多元分析,筛选移植后复发的高危因素.结果 显著影响移植后复发风险的因素因疾病类型不同有所差异.ALL:染色体危险度分层、初始诱导疗程;AML:染色体危险度分层、移植前微量残留病灶水平、白细胞重建时间和移植物中CD4+/CD8+细胞比值;CML:移植前病期.结论 ALL患者移植后复发风险主要取决于本病的危险度,而AML患者移植后复发与移植过程中的多项指标也密切相关,CML患者在移植前保持病情稳定有利于避免移植后复发.染色体危险度分层是影响移植后复发的主要危险因素.

Analysis of high risk factors for relapse of leukemia after allogeneic hematopoietic stem cell transplantation

Objective To screen the high risk factors for relapse after allogeneic hematopoietic stem cell transplantation(allo-HSCT) in acute lymphocytic leukemia (ALL),acute myeloid leukemia (AML) and chronic myeloid leukemia (CML) respectively,then to compare the contribution of each risk factor to relapse and investigate the relevant mechanisms.Methods A retrospective study from single center involved in 262evaluable cases of leukemia received allo-HSCT over the past 8 years,of them 69 cases with ALL,90 AML ( except APL) and 103 CML.Cox proportional hazard regression model was used for univariate and multivariate analysis to screen the high risk factors.Results The risk factors significantly affecting relapse in ALL included:Cytogenetic risk classification,the cycles of initial induction chemotherapy; AML:Cytogenetic risk classification,minimal residual disease (MRD) level before transplant,reconstitution of WBC,and CD4+/CD8 + lymphocyte ratio in the graft; CML:disease stage before transplant.Conclusions The relapse risk after HSCT of ALL mainly depends on the grade of malignancies,and the relapse risk of AML is closely related to the course of transplant.Chronic phase of CML favors a good prognosis after HSCT.Cytogenetic risk classification is the most relevant predictor of relapse after HSCT.