亲缘外周造血干细胞移植治疗急性髓系白血病64例疗效及预后分析

本研究分析亲缘外周造血干细胞移植 （related peripheral blood hematopoietic stem cell transplantation）治疗急性髓系白血病（AML）的疗效及影响疗效的相关因素。对2008年4月-2011年12月在本院进行亲缘PBHSCT的AML患者64例进行回顾性分析，计算其总生存率（OS）、无白血病生存率（1eukemia—freesurvival，LFS）和累积复发率（relapserate，RR），并对影响疗效的因素进行统计学分析。结果表明，3年OS及LFS分别为61．9％％及52％，累积复发率为39．1％。急性移植物抗宿主病（aGVHD）的总发生率为37．5％，其中Ⅱ-Ⅳ度aGVHD发生率为29．7％。单因素分析显示，移植前疾病疗效（P=0．001）、移植供体类型（P=0．002）、初诊时白细胞数量（P=0．018）与OS相关。重度aGVHD（Ⅱ度以上aGVHD）对于OS有一定影响（P=0．070）。多因素分析显示，移植前疗效、移植供体类型、重度aGVHD是影响亲缘PBHSCT治疗AML疗效的独立预后因素。结论：亲缘PBHSCT是治疗AML的有效方法，复发是移植治疗后失败的主要原因，移植前疾病的治疗疗效、移植供体类型、重度aGVHD是独立预后因素。

Outcome and Prognosis in Acute Myeloid Leukemia Patients Treated with Related Peripheral Blood Hematopoietic Stem Cell

This study was purposed to evaluate the outcome of acute myeloid leukemia patients treated with related peripheral blood hematopoietic stem cell transplantation （PBHSCT） and analyse the potential prognostic factors. A total of 64 acute myeloid leukemia patients treated with related peripheral allo-HSCT from march 2008 to august 2012 in our hospital were enrolled in the analysis. All the patients received either HLA-matehed related or mismatched related donor mobilized peripheral blood stem cells. All the patients were followed up and evaluated for overall survival （ OS ）, leukemia-free survival（LFS） and relapse rate （RR）, and the potential prognostic factors well analyzed. The results showed that the 3 year OS , LFS and RR were 61.9%, 52% and 39. 1% respectively. Univarite analysis demonstrated that the disease status before transplantation （ P 〈 0. 01 ）, donor type （ P 〈 0.01 ）, white blood cell count at initial diagnosis（ P 〈 0.05 ） are related with outcome, and severe aGVHD has some influence on the outcome （P 〉 0.05 ）. Multivariate analysis indicated the status of disease before transplantation, donor type, severe aGVHD are the most important prognostic factors. It is concluded that the related PBHSCT is effective treatment method for AML patients, recurrence is the main reason for the failure after transplantation, disease status before transplantation, donor type, and severe aGVHD are independent prognostic factors.