摘要： 目的 探讨急性髓系白血病(AML)异体造血干细胞移植(allo-HSCT)后复发的临床特点及危险因素。方法 收集2012年1月至2021年1月于中国医科大学附属第一医院血液科接受allo-HSCT后复发的12例AML病例,统计其临床一般信息、造血干细胞移植情况、复发后治疗情况以及随访结果等。结果 12例患者造血干细胞均成功植活,其中8例血液学复发,复发中位时间4个月; 4例分子生物学复发,复发中位时间4.5个月。8例血液学复发患者无一例发生急性及慢性移植物抗宿主病(a/cGVHD),其中4例患者于复发后行化疗+供者淋巴细胞输注(DLI)治疗,1例行二次同供者allo-HSCT,另外3例患者复发后放弃治疗,最终8例患者均不同时间死亡。4例分子生物学复发患者中,1例快速减停免疫抑制剂后出现cGVHD,已持续缓解6年; 3例予以地西他滨+DLI治疗,其中1例出现aGVHD,截至目前已持续缓解3年,1例无GVHD,已持续缓解2年,1例出现aGVHD,持续缓解近3个月,最终死于重症感染。结论 无论接受全相合或半相合allo-HSCT的AML患者,血液学复发前通常无GVHD,化疗+DLI治疗效果差,无法诱发GVHD、增强移植物抗白血病(GVL)效应。而分子生物学复发患者给予快速减停免疫抑制剂及干预性DLI治疗,更易出现GVHD,增强GVL效应,白血病持久缓解,故早期复发的监测和抢先治疗可显著提高疗效。

急性髓系白血病异体造血干细胞移植后复发12例分析

苏楠, 刘正华, 李艳, 蔡大利

中国医科大学附属第一医院血液科, 沈阳 110001

收稿日期:2021-12-03出版日期:2022-07-30发布日期:2022-06-27
通讯作者:蔡大利E-mail:cdlwycfy@sina.com
作者简介:苏楠(1982-),女,副主任医师,博士.



关键词: 急性髓系白血病, 异体造血干细胞移植, 复发
Abstract: Objective To investigate the clinical characteristics and risk factors of relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with acute myeloid leukemia (AML) and improve the treatment efficacy and prognosis after alloHSCT. Methods The clinical data of 12 patients with AML who received allo-HSCT in our hospital between January 2012 and January 2021 were retrospectively analyzed. Data on the general clinical situation,hematopoietic stem cell transplantation,treatment after relapse, and follow-up were collected. Results All 12 patients showed successful engraftment,among which 8 patients developed hematologic relapse and 4 developed molecular relapse within a median time of 4 and 4.5 months,respectively. None of the 8 patients with hematologic relapse developed acute or chronic graft-versus-host disease (a/cGVHD). However,among these patients,4 received chemotherapy plus donor lymphocyte infusion (DLI) after relapse,one underwent secondary allogeneic hematopoietic stem cell transplantation,and 3 halted treatment. Ultimately,all 8 patients died. Among the 4 patients with molecular relapse,one developed cGVHD after rapid immunosuppressant withdrawal,which has been in remission for 6 years. The other three patients were treated with decitabine plus DLI. Of these three patients,one developed aGVHD,which has been in remission for 3 years,another had no GVHD and has been in remission for 2 years, the third patient was in remission and developed aGVHD,which lasted for nearly 3 months,and finally died of severe infection. Conclusion GVHD is often absent before hematologic relapse regardless of whether the patients with AML received matched or mismatched all HSCT. Chemotherapy combined with DLI has a poor therapeutic effect and could neither induce GVHD nor enhance the graft versus leukemia (GVL) effect. However,patients with molecular relapse are more likely to develop GVHD when treated with the rapid withdrawal of immunosuppressant or interventional DLI,thus enhancing the GVL effect and prolonging leukemia remission. Therefore,monitoring and preemptive treatment of early recurrence could significantly improve treatment efficacy.
Key words: acute myeloid leukemia, allogeneic hematopoietic stem cell transplantation, relapse
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