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目的探讨中高剂量化疗联合自体外周血干细胞支持治疗急性白血病(AL)的疗效。方法将38例处于完全缓解状态的AL患者分为治疗组和化疗组,治疗组20例由于采集自体外周血干细胞数量不足等原因无法进行自体移植,在行1个疗程中高剂量化疗后回输自体外周血干细胞进行支持治疗,化疗组18例使用中高剂量化疗治疗2～4个疗程,比较两组治疗后造血恢复、感染发生、复发及3年无白血病生存情况。结果治疗组19例患者最终获得造血恢复,中性粒细胞连续3d>0.5×109/L和血小板连续7d>20×109/L的平均时间分别为(11.80±0.986)d,(12.80±0.848)d,与化疗组比较差异有统计学意义(P中性粒=0.04,P血小板=0.042)。38例患者中位随访时间19(7～48)个月,8例出现感染,感染率两组差异有统计学意义(40.0%vs.77.8%,P=0.02);7例复发,复发率为35%;5例死亡,15例仍存活(12例无复发存活),根据Kaplan-Meier生存分析,预计3年无白血病生存率(LFS)治疗组为(67.7±12.3)%,高于化疗组(47.9±12.1)%,但差异无统计学意义(P=0.075)。结论中高剂量化疗联合自体外周血干细胞支持治疗AL安全可靠,治疗后造血恢复较快,复发率及感染发生率低于化疗组,可提高AL患者生存质量,是采集自体外周血干细胞后无法进行移植的AL患者缓解后巩固治疗的又一临床选择。
Objective To investigate the effect of medium-high dose chemotherapy combined with autologous peripheral blood stem cell transplantation in the treatment of acute leukemia (AL). Methods Thirty-eight patients with AL were divided into two groups: treatment group and chemotherapy group. In the treatment group, autologous transplantation was impossible in 20 patients due to insufficient number of peripheral blood stem cells collected in the treatment group. After one course of chemotherapy, In the chemotherapy group, 18 cases were treated with medium and high doses of chemotherapy for 2 to 4 courses of treatment. The hematopoietic recovery, infection, recurrence and 3-year non-leukemia survival were compared between the two groups after treatment. Results In the treatment group, the hematopoietic recovery was achieved in 19 patients. The average time of continuous neutrophil granulocyte 3d> 0.5 × 109 / L and platelet continuous 7 days> 20 × 109 / L were (11.80 ± 0.986) d and (12.80 ± 0.848) d, compared with the chemotherapy group, the difference was statistically significant (P neutrophil = 0.04, P platelet = 0.042). Among the 38 patients, the median follow-up time was 19 (range, 7 to 48) months, and 8 cases were infected. The infection rate was significantly different between the two groups (40.0% vs 77.8%, P = 0.02) 35%, 5 died, and 15 survived (12 without recurrence). According to the Kaplan-Meier survival analysis, the 3-year LFS treatment group was 67.7 ± 12.3% higher than the chemotherapy group (47.9 ± 12.1)%, but the difference was not statistically significant (P = 0.075). Conclusion High-dose chemotherapy combined with autologous peripheral blood stem cell transplantation has the advantages of safe and reliable AL, rapid hematopoietic recovery after treatment, lower recurrence rate and infection rate than chemotherapy group, which can improve the quality of life of patients with AL, which can not be transplanted from peripheral blood stem cells AL patients with another clinical option of remission consolidation therapy.