难治复发性白血病患者造血干细胞移植后复发的分析

目的分析难治复发性白血病患者接受异基因造血干细胞移植(allo-HSCT)后复发的生存预后情况及影响因素。方法回顾性分析140例难治复发性白血病患者,其中急性髓系白血病69例,急性淋巴细胞白血病46例,慢性粒细胞白血病11例,急性混合型白血病10例,淋巴瘤白血病4例;移植前处于完全缓解(CR)49例,未缓解(NR)91例;诊断为中枢神经系统白血病(CNSL)28例。结果观察期内87例死亡,总死亡率为62.1%(87/140),复发率为39.3%(55/140),复发相关死亡为25.7%(36/140)。5年总生存率(OS)为(36.7±5.2)%,无病生存率(DFS)为(31.2±5.5)%。年龄≥40岁、移植前疾病NR状态、中枢侵犯、Ⅱ~Ⅳ°移植物抗宿主病均为影响难治复发白血病患者造血干细胞移植后复发相关死亡的独立危险因素。结论 allo-HSCT是挽救性治疗难治复发性白血病患者的有效手段,移植后复发是影响患者生存率的主要因素之一。降低移植后复发率是提高难治复发性白血病患者allo-HSCT后DFS的关键。

Analysis of relapse in patients with refractory/relapsed leukemia after allogeneic hematopoietic stem cell transplantation

Objective To retrospectively analyze the survival and prognosis of relapse in patients with refractory/relapsed leukemia after allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Methods 140 refractory/relapsed patients were enrolled for the study, including 69 with acute myeloid leukemia, 46 with acute lymphocytic leukemia, 11 with chronic myeloid leukemia, 10 with mixed leukemia and 4 with lymphoma leukemia. Among them, 49 were in complete remission （CR）, 91 in non-remission（NR）, and 28 diagnosed with central nervous system leukemia（CNSL）. Results 87 of the patients died after the transplantation. The overall mortality was 62.1% （87/140）. The relapse rate was 39.3% （55/140） and relapse-related mortality was 25.7% （36/140）of the patients. The 5-year overall survival （OS）and disease-free survival （DFS） was （36.7 ± 5.2）% and （31.2 ± 5.5）% among these patients, respectively. Multivariate analysis showed that age≥40 years, NR status, CNSL and Ⅱ-Ⅳ° graft-versus-host diseases （GVDH） were independent risk factors of relapse-related mortality after allo-HSCT. Conclusion Allo-HSCT is an effective salvage therapy for patients with refractory/relapsed leukemia. Relapse after transplantation is one of the main factors affecting survival of patients. Reducing the relapse rate after transplantation is the key to improving the DFS of refractory/relapsed leukemia patients after allo-HSCT.