引用本文:张 敏,刘 玲,姜文娜,刘焕平,陈璐璐,张 颢.自体造血干细胞移植治疗急性髓系白血病的疗效及安全性单中心回顾性研究[J].中国临床新医学,2023,16(11):1115-1120.
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自体造血干细胞移植治疗急性髓系白血病的疗效及安全性单中心回顾性研究
张 敏,刘 玲,姜文娜,刘焕平,陈璐璐,张 颢
272007 山东,济宁医学院附属医院血液内科
摘要:
[摘要] 目的 探讨自体造血干细胞移植治疗急性髓系白血病(AML)的临床疗效及安全性。方法 回顾性分析2017年3月至2022年10月于济宁医学院附属医院血液内科行自体造血干细胞移植治疗的18例AML患者的临床资料。根据法、英、美分型系统(FAB)分型,M2型3例,M4型9例,M5型6例。根据美国国立综合癌症网络(NCCN)指南,低危6例,中危8例,高危4例。其中11例患者为移植前第1次完全缓解(CR1),7例患者为移植前第2次完全缓解(CR2)。所有患者的造血干细胞来自于外周血,其中18例采用化疗药物+粒细胞集落刺激因子(G-CSF)动员;2例因第1次采集CD34+数量不足,第2次采用普乐沙福动员。18例患者输注CD34+计数中位数为4.05×106/kg(1.87×106~27.40×106/kg),单个核细胞计数中位数为14.48×108/kg(4.07×108~24.74×108/kg)。结果 18例患者中性粒细胞植入的中位时间为10(9~13)d,血小板植入的中位时间为15(10~19)d。3年的总生存率及无白血病生存率分别为73.00%及72.00%。BuCy预处理患者复发率为33.33%,含BuMel预处理方案复发率为12.50%。18例患者均有不同的消化道反应。6例以BuCy为预处理方案的患者,血液外的不良反应表现为Ⅰ~Ⅱ度腹泻,心慌、胸闷,转氨酶升高,低钾血症。1例移植后出现植入综合征。8例含BuMel预处理方案的患者,血液外的不良反应表现为Ⅰ~Ⅱ度口腔溃疡,低钾血症。18例患者未发生移植相关死亡。结论 自体造血干细胞移植是AML患者缓解后安全、有效的巩固治疗选择。BuMel预处理方案有更轻的不良反应及更低的复发率,可作为AML患者自体造血干细胞移植预处理的首要选择。
关键词:  急性髓系白血病  自体造血干细胞  移植
DOI:10.3969/j.issn.1674-3806.2023.11.03
分类号:R 733.71
基金项目:山东省自然科学基金项目(编号:ZR2021MH320)
Efficacy and safety of autologous hematopoietic stem cell transplantation for patients with acute myeloid leukemia:a single-center retrospective study
ZHANG Min, LIU Ling, JIANG Wen-na, et al.
Department of Hematology, Affiliated Hospital of Jining Medical University, Shandong 272007, China
Abstract:
[Abstract] Objective To investigate the clinical efficacy and safety of autologous hematopoietic stem cell transplantation(auto-ASCT) in treatment of acute myeloid leukemia(AML). Methods The clinical data of 18 patients with AML who underwent auto-ASCT in the Department of Hematology of Affiliated Hospital of Jining Medical University from March 2017 to October 2022 were retrospectively analyzed. According to French-American-British classification systems(FAB), the patients were classified into M2 type(3 cases), M4 type(9 cases), and M5 type(6 cases). According to National Comprehensive Cancer Network(NCCN) guidelines, the patients with AML were classified into 3 cytogenetic prognostic groups: low risk(6 cases), intermediate risk(8 cases) and high risk(4 cases), among whom, 11 patients were in the first complete remission(CR1) before the transplantation and 7 patients in the second complete remission(CR2) before the transplantation. Hematopoietic stem cells of all the patients were derived from peripheral blood, among whom 18 cases were mobilized by chemotherapy drugs+granulocyte colony-stimulating factor(G-CSF), and 2 cases were mobilized by plerixafor in the second time due to the insufficient quantity collected in the first time. The median count number of infused CD34+ cells was 4.05×106/kg(1.87×106-27.40×106/kg) and the median count number of infused mononuclear cells was 14.48×108/kg(4.07×108-24.74×108/kg) in the 18 cases. Results The median time of neutrophil engraftment in the 18 cases was 10(9-13)days, and their median time of platelet engraftment was 15(10-19)days. The 3-year overall survival rate and leukemia-free survival rate were 73.00% and 72.00%, respectively. The relapse rate was 33.33% in the patients with BuCy-based conditioning regimen and 12.50% in the patients with BuMel-based conditioning regimen. All the 18 patients had different gastrointestinal reactions. In the 6 patients with BuCy-based conditioning regimen, the adverse reactions outside the bloodstream included Ⅰ-Ⅱ diarrhea, palpitation, chest tightness, elevated transaminase, and hypokalemia.One patient developed engraftment syndrome after transplantation. Eight patients with BuMel-based conditioning regimen had the adverse reactions outside the bloodstream including grade Ⅰ-Ⅱ oral ulcer and hypokalemia. No transplant-associated death occurred in any of the 18 patients. Conclusion Auto-ASCT is a safe and effective consolidation treatment option for AML patients after complete remission. BuMel-based conditioning regimen has slighter adverse reactions and lower relapse rate, and can be used as the first choice of conditioning regimen for AML patients with auto-ASCT.
Key words:  Acute myeloid leukemia(AML)  Autologous hematopoietic stem cell  Transplantation