薛慧,
李敏,
刘志彬,
胡永超,
谢宗源,
高峰^,
华北理工大学附属医院 血液科，河北 唐山 063000

基金项目: 河北省省级科技计划资助项目（22377738D）；河北省医学科学研究课题计划项目（20210535）


详细信息 作者简介: 薛 慧（1981-），女，副主任医师，副教授。E-mail：xuehuits@163.com






通讯作者: 高 峰，主任医师，副教授。E-mail：tgxueye@163.com 中图分类号: R552


摘要:目的分析急慢性白血病患者行亲缘间、外周血异基因造血干细胞移植（Allo-HSCT）后复发的危险因素。方法选取2016年1月至2020年10月期间行Allo-HSCT的62例白血病患者为研究对象，其中急性髓系白血病（AML）30例，急性淋巴细胞白血病（ALL）24例，慢性粒细胞白血病（CML）8例。造血干细胞来源均为亲缘供者外周血，给予改良BU/CY±ATG清髓性预处理方案，统计移植后疾病复发情况，分析复发的危险因素。结果随访至2021年10月，中位随访时间为38（12～52）个月，共20例患者复发，总体复发率为32.3%（20/62），其中，AML复发率为33.3%（10 /30），ALL复发率为37.5%（9/24），CML复发率为12.5%（1/8）。单因素分析显示，移植后复发的发生与患者性别、年龄、疾病类型、血型、人类白细胞抗原（HLA）配型、初诊时伴髓外病变、急性移植物抗宿主病（aGVHD）的发生、巨细胞病毒（CMV）感染无明显关系（P＞0.05）；与移植前微小残留病（MRD）水平、慢性移植物抗宿主病（cGVHD）的发生有关，移植前MRD阳性、移植后未并发cGVHD患者的复发率更高（P＜0.05）；多因素分析显示，移植前MRD水平是移植后复发的危险因素。结论移植前MRD阳性是亲缘间、外周血Allo-HSCT后复发的危险因素。
关键词: 外周血异基因移植/
白血病/
复发/
危险因素


Abstract:ObjectiveTo analyze the risk factors of relapse in patients with acute and chronic leukemia after interrelated peripheral blood allogeneic hematopoietic stem cell transplantation (Allo-HSCT).Methods Total of 62 leukemia patients who underwent Allo-HSCT between January 2016 and October 2020 were enrolled in the study. Among them, 30 patients had acute myeloid leukemia (AML), 24 acute lymphocytic leukemia (ALL), and 8 chronic myeloid leukemia (CML). Hematopoietic stem cells were all derived from peripheral blood of related donors. The modified BU/CY±ATG myeloablative conditioning regimen was used prior to Allo-HSCT. Disease recurrence and its risk factors were analyzed.ResultsThe patients were followed up until October 2021 with a median follow-up time of 38 (12-52) months. A total of 20 patients relapsed with an overall relapse rate of 32.3% (20/62). Among them, AML was 33.3% (10/30), ALL 37.5% (9/24), CML 12.5% (1/8). Univariate analysis revealed no significant correlation between relapse and sex, age, disease type, blood type, human leukocyte antigen (HLA) matching, extramedullary disease at initial diagnosis, acute graft-versus-host disease (aGVHD), cytomegalovirus (CMV) infection (P＞0.05). The relapse rate was significantly correlated with the level of minimal residual disease (MRD) before transplantation and the occurrence of chronic graft-versus-host disease (cGVHD). Patients with MRD before transplantation and without cGVHD after transplantation had a higher relapse rate (P＜0.05). Multivariate analysis revealed that the level of MRD before transplantation was a risk factor for relapse (P＜0.05).ConclusionPositive MRD before transplantation is a risk factor of leukemia relapse after interrelated peripheral blood Allo-HSCT.
Keywords:peripheral blood allogeneic transplantation/
leukemia/
relapse/
risk factors

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