异基因造血干细胞移植术治疗骨髓增生异常综合征患者临床疗效的分析

目的:分析异基因造血干细胞移植术(allo-HSCT)治疗骨髓增生异常综合征(MDS)患者的临床疗效,并探讨移植后复发的治疗新策略.方法:选取并回顾性分析2013年4月至2019年11月于北京大学第一医院行allo-HSCT 的MDS患者共72例,总结移植疗效,并对影响患者生存及复发的危险因素进行探讨.结果:72例患者...

Clinical Efficacy of the MDS Patients Treated by Allo-HSCT

Objective:To analyze clinical effectiveness of myelodysplastic syndrome(MDS) patients treated by allogeneic hematopoietic stem cell transplantation(allo-HSCT),and to investigate new therapy strategy for the treatment of relapse after allo-HSCT.Methods:72 MDS patients treated by HSCT in our hospital from April 2013 to November2019 were enrolled and analyzed retrospectively.The effect of allo-HSCT was summarized.The risk factors affecting the survival and relapse of the patients were investigated.Results:Among 72 patients,the median follow up was 37(12-111) months.57 patients survived(79.2%),while 15 patients died(20.8%).The 5-year overall survival(OS) rate and 5-year disease-free survival(DFS) rate were 76.6% and 62.3%,respectively.IPSS-R,TP53 mutation and chronic graft versus-host-disease(cGVHD) were the risk factors affecting the OS of the MDS patients after treated by alloHSCT.IPSS-R,TP53 mutation and Ⅲ-Ⅳ°acute graft versus-host-disease(aGVHD) were the risk factors affecting the DFS of the MDS patients after treated by allo-HSCT.After transplanted,19 patients(26.4%) emerged aGVHD,and 5 patients(6.9%) emerged Ⅲ-Ⅳ°aGVHD,25 patients(34.7%) emerged cGVHD,while 4 patients(5.6%)emerged extensive cGVHD.17 patients(23.3%) relapsed,and the 5-year cumulative incidence of relapse(CIR) rate was 27.5%.IPSS-R,TP53 mutation and cGVHD were the risk factors affecting the relapse of the patients.The median survival time after relapse was 9 months.There were 7 out of 17 relapsed patients survived without disease,while 10 patients died.The OS rate of patients treated with maintained hypomethylation agents(HMA) combined with G-CSF mobilized donor lymphocyte infusion(DLI) was significantly higher than the patients without HMA(80.0% vs 10.0%,P=0.002).Conclusion:Allo-HSCT is an effective therapy for intermediate and high risk MDS patients.But relapse after HSCT is still a major problem that affecting the survival of the patients.Maintenance treatment of HMA combined with DLI may improve the long-time survival of MDS patients with relapsed after treated by allo-HSCT.