中国组织工程研究

中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (9): 1450-1455.doi: 10.3969/j.issn.2095-4344.2017.09.025

• 干细胞移植 stem cell transplantation • 上一篇    下一篇

异基因造血干细胞移植治疗染色体核型预后中等急性髓系白血病

张文荟1，迟凯凯2，陈玉清1，杨  靖1，朱尊民1，孙  恺1，张  茵1   

  1. 1河南省人民医院血液科，河南省郑州市  450002；2河南中医药大学第一附属医院泌尿外肾移植科，河南省郑州市  450000
  • 出版日期:2017-03-28 发布日期:2017-03-31
  • 通讯作者: 陈玉清，硕士，主任医师，河南省人民医院血液科，河南省郑州市 450002
  • 作者简介:张文荟，女，1987年生，河南省郑州市人，汉族，2013年郑州大学毕业，硕士，主治医师，主要从事血液系统疾病研究。
  • 基金资助:

    国家自然科学基金面上项目(81273259)，项目名称：受者“Unlicensed”Ly49+NK 细胞亚群在特异性调节异基因移植排斥反应中的作用及机制

Allogeneic hematopoietic stem cell transplantation for intermediate cytogenetic risk acute myeloid leukemia

Zhang Wen-hui1, Chi Kai-kai2, Chen Yu-qing1, Yang Jing1, Zhu Zun-min1, Sun Kai1, Zhang Yin1   

  1. 1Henan Provincial People’s Hospital, Zhengzhou 450002, Henan Province, China; 2Department of Kidney Transplantation, First Affiliated Hospital of Henan University of TCM, Zhengzhou 450000, Henan Province, China
  • Online:2017-03-28 Published:2017-03-31
  • Contact: Chen Yu-qing, Master, Chief physician, Henan Provincial People’s Hospital, Zhengzhou 450002, Henan Province, China
  • About author:Zhang Wen-hui, Master, Attending physician, Henan Provincial People’s Hospital, Zhengzhou 450002, Henan Province, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81273259

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摘要：

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文题释义：
染色体核型：将一个体细胞中的全部染色体按一定方式排列起来，就构成染色体核型。简单而言，是指体细胞染色体在光学显微镜下所有可测定的表型特征的总称。一般包括染色体数目、大小、形态及结构。
造血干细胞移植分类：①按造血干细胞的来源部位可分为骨髓移植、外周血干细胞移植和脐血干细胞移植；②按照供者与受者的关系分为自体移植、同基因移植和异基因移植。其中同基因移植是指患者与移植供者为同卵孪生兄弟或姐妹；③根据供者与受者HLA配型相合程度分为HLA全相合移植、不全相合移植、单倍体相合移植；④根据移植前的预处理方案强度可分为：清髓性造血干细胞移植和非清髓性造血干细胞移植(减低预处理剂量的造血干细胞移植)。

 

摘要
背景：以往研究显示完全缓解期染色体核型预后中等的急性髓系白血病患者行亲缘全相合异基因外周血造血干细胞移植有较高的无病生存率和总体生存率，但影响移植预后的相关因素并未完全明确。
目的：评价HLA相合异基因外周血造血干细胞移植治疗完全缓解期染色体核型预后中等急性髓系白血病的疗效，并对预后相关因素进行分析。
方法：对2009年1月至2015年1月进行HLA全相合异基因外周血造血干细胞移植的50例完全缓解期染色体核型预后中等的急性髓系白血病患者进行回顾性分析，计算总体生存率，并对影响预后的各因素进行统计学分析。

结果与结论：①4年总体生存率为64%，累积复发率及移植相关非复发死亡率分别为18%及20%。急性移植物抗宿主病的总体发生率为26%；②女性供者男性受者配对移植患者4年总体生存率低于非女性供者男性受者移植患者(P=0.041)；移植前大于1个疗程才能达完全缓解的患者4年总体生存率低于移植前1个疗程能达完全缓解的患者(P=0.038)；年龄≥40岁的患者4年总体生存率低于年龄< 40岁的患者(P=0.056)；亲缘供者移植和非亲缘移植患者的4年总体生存率差异无显著性意义(P=0.427)。女性供者男性受者移植及年龄≥40岁患者移植相关非复发死亡率明显增高(P值分别为0.024和0.043)；③多因素分析确认，与移植预后相关的因素有：女性供者男性受者配对移植(P=0.031，RR=1.38，95%CI 1.03-1.95)、移植前大于1个疗程才能达完全缓解(P=0.016，RR=1.46，95%CI 1.10-1.98)、年龄≥40岁(P=0.024，RR=1.63，95%CI 1.32-2.12)；④结果表明，HLA全相合异基因外周血造血干细胞移植是染色体核型预后中等急性髓系白血病缓解后治疗的有效方法。女性供者男性受者配对移植、移植前大于1个疗程才能达完全缓解、年龄≥40岁是影响这类患者预后的主要危险因素。这类患者行异基因外周血造血干细胞移植时，供者受者的性别组合比是否为亲缘供者更为重要。

 

中国组织工程研究杂志出版内容重点：干细胞；骨髓干细胞；造血干细胞；脂肪干细胞；肿瘤干细胞；胚胎干细胞；脐带脐血干细胞；干细胞诱导；干细胞分化；组织工程

ORCID: 0000-0003-1349-3644(张文荟)

关键词: 干细胞, 移植, 白血病, 急性髓系白血病, 染色体核型预后中等, HLA相合异基因造血干细胞移植, 国家自然科学基金

Abstract:

BACKGROUND: Previous studies have shown that HLA-identical sibling allogeneic peripheral blood hematopoietic stem celltransplantation (allo-HSCT) provides higher disease-free and overall survival rates for patients with intermediate cytogenetic risk acute myeloid leukemia (AML) in complete remission (CR). But prognosis factors have not been fully defined.

OBJECTIVE: To evaluate the outcome of patients with intermediate cytogenetic risk AML undergoing HLA-matched allo-HSCT in CR, and to analyze the prognostic factors.
METHODS: Fifty cases of intermediate cytogenetic risk AML in CR receiving HLA-matched allo-HSCT from January 2009 to January 2015 were retrospectively analyzed. Primary outcome measures of the study included overall survival (OS), relapse rate and non-relapse mortality.

RESULTS AND CONCLUSION: The 4-year OS of the study population reached to 64%, and the relapse rate and NRM reached to 18% and 20% respectively. Incidence of acute graft-versus-host disease was 26%. Different prognosis was observed between female donor/male recipient (FDMR) combination transplant and control (4-year OS: 50% vs. 71.9%, P=0.041), between patients requiring more than one course of induction chemotherapy to achieve CR and control (4-year OS: 40% vs. 70%, P=0.038), between older age (≥ 40 years) and control (4-year OS: 44.4% vs. 68.3%, P=0.056). The 4-year OS for matched sibling donor and matched unrelated donor was 63.2% and 66.7% (P=0.427), respectively. Further analysis revealed significantly high non-relapse mortality in FDMR combination transplant (P=0.024) and older age (≥ 40 years; P=0.043). Multivariate analysis revealed three negative prognostic factors: FDMR combination (P=0.031, RR=1.38, 95% CI: 1.03-1.95), requiring more than one course of induction chemotherapy to achieve CR (P=0.016, RR=1.46, 95% CI: 1.10-1.98) and older age (≥ 40 years; P=0.024, RR=1.63, 95% CI: 1.32-2.12). To conclude, HLA-matched allo-HSCT is a choice for the intermediate cytogenetic risk AML case in CR. FDMR combination, requiring more than one course of induction chemotherapy to achieve CR and older age (≥ 40 years) are confirmed as risk factors of poor prognosis for HLA-matched allo-HSCT patients with intermediate cytogenetic risk AML in CR. To these cases, the donor-recipient sex combination is more important than the donor type in donor selection.

 

中国组织工程研究杂志出版内容重点：干细胞；骨髓干细胞；造血干细胞；脂肪干细胞；肿瘤干细胞；胚胎干细胞；脐带脐血干细胞；干细胞诱导；干细胞分化；组织工程

Key words: Leukemia, Myeloid, Acute, Hematopoietic Stem Cell Transplantation, XYY Karyotype, Tissue Engineering

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