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目的探讨难治复发急性淋巴细胞白血病(acute lymphocytic leukemia,ALL)的缓解状态对异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)预后的影响。方法回顾性分析我研究所不同缓解状态下行allo-HSCT的52例难治复发ALL患者,其中19例处于未缓解(non-remission,NR)状态,33例达到第2次及以上完全缓解(complete remission,≥CR2)。所有患者均采用清髓性预处理,其中改良白消安加环磷酰胺37例,全身照射加环磷酰胺14例。结果除1例患者早期死亡外,其余51例均获得造血重建,NR和≥CR2患者100 d内移植相关死亡为10.5%和12.1%(P=1.000)。移植后急性移植物抗宿主病(graft versus host disease,GVHD)发生率为52.6%和57.6%(P=0.730),其中Ⅰ~Ⅱ度为42.1%和33.3%(P=0.527),Ⅲ~Ⅳ度为10.5%和24.3%(P=0.399),慢性GVHD发生率为41.6%和57.9%(P=0.660)。中位随访时间为12(1.8~44.5)个月,26例患者无白血病生存至今。NR与≥CR2患者的预计2年总生存(overall survival,OS)和无白血病生存(leukemia-free survival,LFS)分别为42.6%、45.7%(P=0.740)和46.3%、46.2%(P=0.998),累积复发率为47.0%、34.3%(P=0.425)。影响预后的单因素和多因素分析显示,移植前疾病缓解状态与生存无关,移植后发生慢性GVHD才是影响OS、LFS的独立预后因素。结论移植前NR患者与≥CR2患者相比,移植预后无统计学差异,提示allo-HSCT挽救性治疗NR状态下难治复发的ALL是可行的。
Objective To investigate the effect of remission status of refractory recurrent acute lymphocytic leukemia (ALL) on the prognosis of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods A retrospective analysis of 52 refractory recurrent ALL patients undergoing allo-HSCT with different remission status in our institute was conducted. Among them, 19 patients were in non-remission (NR) state and 33 patients achieved complete remission in 2nd and above remission, ≥CR2). All patients were used myeloablative pretreatment, including 37 cases of modified busulfan plus cyclophosphamide, systemic irradiation plus cyclophosphamide in 14 cases. Results All the 51 patients were hematopoietic reconstructed except 1 patient died early. The 100% transplant-related deaths in NR and ≥ CR2 patients were 10.5% and 12.1% (P = 1.000). The incidence of graft versus host disease (GVHD) after transplantation was 52.6% and 57.6% (P = 0.730), of which grade Ⅰ ~ Ⅱ was 42.1% and 33.3% (P = 0.527) Rates were 10.5% and 24.3%, respectively (P = 0.399). The incidence of chronic GVHD was 41.6% and 57.9%, respectively (P = 0.660). The median follow-up time was 12 (1.8 to 44.5) months, and 26 patients had no leukemia to date. The estimated 2-year overall survival (OS) and leukemia-free survival (LFS) were 42.6%, 45.7% (P = 0.740), 46.3% and 46.2% in patients with NR and ≥ CR2, respectively 0.998), the cumulative recurrence rate was 47.0%, 34.3% (P = 0.425). Univariate and multivariate analysis showed that the remission status before transplantation was independent of survival, and chronic GVHD after transplantation was the independent prognostic factor of OS and LFS. Conclusion There was no significant difference in the prognosis of all patients with NR before transplantation compared with those with ≥ CR2, suggesting that allo-HSCT is feasible for salvage ALL with refractory relapse in NR.