自体造血干细胞移植治疗急性髓系白血病的疗效观察

孙燕玲; 张競文; 方志刚

doi:10.3969/j.issn.1674-7445.2018.01.009

自体造血干细胞移植治疗急性髓系白血病的疗效观察

doi: 10.3969/j.issn.1674-7445.2018.01.009

510630 广州，中山大学附属第三医院血液内科中山大学血液病研究所

详细信息

作者简介:
孙燕玲，女，1986年生，博士，主治医师，研究方向为造血干细胞移植，Email: 105067713@163.com

通讯作者:
方志刚，男，1970年生，硕士，主治医师，研究方向为急性白血病治疗，Email: fzg92@163.com

中图分类号: R733.71
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出版历程
- 收稿日期: 2017-10-02
- 网络出版日期: 2021-01-19
- 刊出日期: 2018-01-15

Efficacy of autologous hematopoietic stem cell transplantation on the treatment of patients with acute myeloid leukemia

Department of Hematology, the Third Affiliated Hospital of Sun Yat-sen University, Institute of Hematology of Sun Yat-sen University, Guangzhou 510630, China

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Corresponding author: Fang Zhigang, E-mail:fzg92@163.com

摘要

摘要: 目的观察自体造血干细胞移植对完全缓解期的急性髓系白血病（AML）患者的疗效。方法回顾性分析14例行自体造血干细胞移植的AML患者的临床资料，其中低危7例，中危6例，高危1例。预处理后予回输预先冻存的自体外周血造血干细胞，并予成分输血、升白细胞、预防感染等治疗，观察患者的自体干细胞造血重建情况，并了解移植相关并发症的发生情况；绘制生存曲线并计算术后1年和3年的存活率和无病存活（DFS）率。结果 14例患者均获得造血重建，白细胞植入中位时间为12（9~28）d，血小板植入中位时间为29（8~158）d。2例患者粒细胞缺乏期出现大肠杆菌败血症，1例发生普通变形杆菌败血症，1例患者在移植后29 d出现巨细胞病毒血症，其余患者预处理后出现感染或胃肠道反应，经抗感染及其它对症支持等治疗后均治愈。随访时间29.8（5.3~61.5）个月，14例患者中共有5例复发（35.7%），11例患者存活，3例死于复发。术后1年、3年的存活率分别为86%和79%，术后1年、3年的DFS率分别为64%和57%。结论自体造血干细胞移植是大部分低、中危AML患者的有效治疗方法。
- 急性髓系白血病（AML） /
- 自体造血干细胞移植（auto-HSCT） /
- 微小残留病变（MRD） /
- 造血重建 /
- 外周血造血干细胞 /
- 败血症 /
- 巨细胞病毒血症 /
- 无病存活（DFS）
Abstract: Objective To observe the efficacy of autologous hematopoietic stem cell transplantation on the treatment of patients with acute myeloid leukemia (AML) in complete remission stage. Methods Clinical data of 14 AML patients underwent autologous hematopoietic stem cell transplantation were analyzed retrospectively, including 7 low-risk patients, 6 moderate-risk patients and 1 high-risk patient. After pretreatment, pre-cryopreserved autologous peripheral blood stem cells were retransfused. And component blood transfusion, increasing white blood cell (WBC) count and preventing from infection, etc. were given. Hematopoietic reconstitution of autologous stem cells in the patients was observed, and incidence of transplantation related complications was obtained. Furthermore, survival curves were drawn, and postoperative 1-and 3-year overall survival rates and disease-free survival (DFS) rates were calculated. Results Hematopoietic reconstitution was achieved in all 14 patients. The median time of WBC implantation was 12(9-28) d, and that of platelet implantation was 29(8-158) d. Two patients suffered from E. coli septicemia during neutropenia stage, 1 from proteus vulgaris septicemia, 1 from cytomegalovirus viremia within 29 d after transplantation and the remaining from infection or gastrointestinal reaction after pretreated. All patients were cured by anti-infection and other symptomatic relief and supportive treatment. All patients were followed up for 29.8(5.3-61.5) months. In 14 patients, 5 cases recurred. 11 patients survived and 3 died of recurrence. The postoperative 1-and 3-year overall survival rates were 86% and 79%, and the postoperative 1-and 3-year DFS rates were 64% and 57%. Conclusions Autologous hematopoietic stem cell transplantation is effective in the treatment of majority patients with low-or moderate-risk AML.
- Acute myeloid leukemia (AML) /
- Autologous hematopoietic stem cell transplantation (auto-HSCT) /
- Minimal residual disease (MRD) /
- Hematopoietic reconstitution /
- Peripheral blood hematopoietic stem cell /
- Septicemia /
- Cytomegalovirus viremia /
- Disease-free survival

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图 1 14例接受auto-HSCT患者的生存曲线和无病生存曲线

Figure 1. Overall survival curve and DFS curve of 14 patients undergoing auto-HSCT

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表 1 14例AML患者临床资料

Table 1. Clinical data of 14 patients with AML

例序	性别	年龄（岁）	诊断	初诊白细胞计数（×10⁹/L）	融合基因	危险分层	诊断到移植时间（月）	移植前 MRD
1	男	27	M5	15.0	-	中危	7	-
2	女	40	M4Eo	21.0	CBFβ/MYH11	低危	6	-
3	男	53	M2	3.1	AML1/ETO	低危	8	+
4	男	54	M5	29.3	-	中危	7	-
5	男	31	M2	1.9	AML1/ETO	低危	4	-
6	男	16	M5	1.5	-	中危	12	-
7	女	22	髓系肉瘤	4.1	-	中危	9	-
8	女	49	M5	26.4	NPM1	低危	5	+
9	男	15	M2	207.0	CEBPA	高危	5	-
10	男	54	M2	2.1	-	中危	10	+
11	男	17	M4Eo	21.0	CBFβ/MYH11	低危	6	-
12	男	29	M2	35.2	AML1/ETO伴C-KIT	中危	8	-
13	男	33	M2	23.9	AML1/ETO	低危	5	-
14	女	46	M5	2.5	NPM1	低危	6	-

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表 2 14例患者auto-HSCT造血重建及预后

Table 2. Hematopoietic reconstruction and prognosis of 14 patients received auto-HSCT

例序	回输单个核细胞（×10⁸/L）	回输CD34⁺细胞（×10⁶/L）	白细胞植入时间（d）	血小板植入时间（d）	是否复发	复发时间（月）	是否存活	存活时间（月）
1	3.4	3.10	9	14	否	-	是	61.5
2	3.2	0.50	12	34	否	-	是	57.5
3	5.6	1.42	10	12	是	2.8	否	3.9
4	3.7	3.20	9	25	是	6.5	否	7.6
5	3.3	0.60	11	41	否	-	是	42.1
6	3.9	0.36	12	33	否	-	是	37.0
7	5.1	5.04	9	20	否	-	是	32.0
8	3.8	0.60	12	37	否	-	是	27.6
9	3.9	8.60	9	8	是	12.0	是	26.0
10	3.7	0.47	20	120	是	16.0	否	18.2
11	3.0	0.19	16	102	否	-	是	20.5
12	2.1	0.90	12	16	是	5.4	是	14.4
13	4.6	7.26	9	13	否	-	是	9.8
14	7.5	0.07	28	158	否	-	是	5.3
-为无相关数据

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