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本研究评价自体造血干细胞移植(auto-HSCT)与异基因造血干细胞移植(allo-HSCT)治疗成人急性淋巴细胞白血病细胞(ALL)的疗效,分析相关预后因素。对114例造血干细胞移植治疗ALL患者的临床资料进行回顾性分析,其中auto-HSCT共70例,allo-HSCT共44例,比较CR1期行auto-HSCT与allo-HSCT患者的移植相关死亡率(transplantation-related-motality,TRM)及长期随访无病活存率(disease-free survival,DFS)、复发率。结果表明:全体患者8年OS和DFS分别是(40.89±5.27)(和(39.50±5.22)(。CR1期行移植患者和移植时为CR2或CR3及复发患者的3年DFS分别为(47.63±5.63)(和(17.65±9.25)((p=0.0034);44例allo-HSCT发生I/II度aGVHD者2年DFS是(62.75±12.30)(,III/IV度aGVHD者6个月DFS为0,无aGVHD者2年DFS是(29.35±9.70)((p=0.005);auto-HSCT后有维持化疗患者与无维持化疗患者3年DFS分别是(55.12±7.89)(和(33.33±11.11)(,二者差别有统计学意义(p=0.0499);在CR1期行auto-HSCT与allo-HSCT患者的5年DFS之间差别无统计学意义。allo-HSCT患者移植后的复发率明显低于auto-HSCT患者,但差别未达到统计学意义;TRM高于auto-HSCT患者,差别有统计学意义(p=0.0313)。诊断时伴有髓系表达和血乳酸脱氢酶(LDH)水平>2倍正常值是预后差的危险因素。结论:成人ALL患者CR1期选择auto-HSCT和allo-HSCT做为巩固治疗手段可以改善ALL患者预后,二者疗效无显著差别;发生I/II度aGVHD的allo-HSCT患者有较高的DFS;auto-HSCT患者移植后维持化疗可以提高疗效。
This study evaluated the efficacy of auto-HSCT and allo-HSCT in the treatment of adult acute lymphoblastic leukemia cells (ALL) and analyzed the associated prognostic factors. A total of 70 auto-HSCT patients and 44 allo-HSCTs were retrospectively analyzed in 114 hematopoietic stem cell transplantation (ALL) patients. The relative mortality of auto-HSCT and allo-HSCT in CR1 transplantation-related-motality (TRM) and long-term follow-up disease-free survival (DFS) and recurrence rate. The results showed that the 8-year OS and DFS of all patients were (40.89 ± 5.27) and (39.50 ± 5.22) respectively. (3) The 3-year DFS of CR1 or CR3 patients with CR1 or CR3 transplantation were 47.63 ± (62.75 ± 12.30) in the 44 cases of allo-HSCT with aGVHD of grade a / II (DFS was 5.65 (5.65 ± 9.25) vs (17.65 ± 9.25), respectively (2) The 2-year DFS of patients without aGVHD was (29.35 ± 9.70) (p = 0.005). The 3-year DFS of patients with and without maintenance chemotherapy after auto-HSCT were 55.12 ± 7.89 and 33.33 ± 11.11, respectively ), (P = 0.0499). There was no significant difference in 5-year DFS between auto-HSCT and allo-HSCT in CR1 patients.The recurrence rate was significantly higher in all-HSCT patients after transplantation Lower than that in auto-HSCT, but the difference did not reach statistical significance; TRM was higher than auto-HSCT patients, the difference was statistically significant (p = 0.0313) .Immunocytosis and lactic dehydrogenase (LDH) Level> 2 times of normal value is a risk factor of poor prognosis.Conclusion: The auto-HSCT and allo-HSCT in CR1 in adult patients with ALL can improve the prognosis of patients with ALL, and there is no significant difference between them in the efficacy of I / II Degree allo-HSCT with aGVHD Have a higher DFS; auto-HSCT in patients on maintenance chemotherapy after transplantation may improve the outcome.