摘要
目的探讨自体造血干细胞移植治疗急性髓系白血病(AML)的临床疗效及安全性。方法回顾性分析2017年3月至2022年10月于济宁医学院附属医院血液内科行自体造血干细胞移植治疗的18例AML患者的临床资料。根据法、英、美分型系统(FAB)分型,M_(2)型3例,M_(4)型9例,M_(5)型6例。根据美国国立综合癌症网络(NCCN)指南,低危6例,中危8例,高危4例。其中11例患者为移植前第1次完全缓解(CR1),7例患者为移植前第2次完全缓解(CR2)。所有患者的造血干细胞来自于外周血,其中18例采用化疗药物+粒细胞集落刺激因子(G-CSF)动员;2例因第1次采集CD34^(+)数量不足,第2次采用普乐沙福动员。18例患者输注CD34^(+)计数中位数为4.05×10^(6)/kg(1.87×10^(6)~27.40×10^(6)/kg),单个核细胞计数中位数为14.48×108/kg(4.07×108~24.74×108/kg)。结果18例患者中性粒细胞植入的中位时间为10(9~13)d,血小板植入的中位时间为15(10~19)d。3年的总生存率及无白血病生存率分别为73.00%及72.00%。BuCy预处理患者复发率为33.33%,含BuMel预处理方案复发率为12.50%。18例患者均有不同的消化道反应。6例以BuCy为预处理方案的患者,血液外的不良反应表现为Ⅰ~Ⅱ度腹泻,心慌、胸闷,转氨酶升高,低钾血症。1例移植后出现植入综合征。8例含BuMel预处理方案的患者,血液外的不良反应表现为Ⅰ~Ⅱ度口腔溃疡,低钾血症。18例患者未发生移植相关死亡。结论自体造血干细胞移植是AML患者缓解后安全、有效的巩固治疗选择。BuMel预处理方案有更轻的不良反应及更低的复发率,可作为AML患者自体造血干细胞移植预处理的首要选择。
Objective To investigate the clinical efficacy and safety of autologous hematopoietic stem cell transplantation(auto-ASCT)in treatment of acute myeloid leukemia(AML).Methods The clinical data of 18 patients with AML who underwent auto-ASCT in the Department of Hematology of Affiliated Hospital of Jining Medical University from March 2017 to October 2022 were retrospectively analyzed.According to French-American-British classification systems(FAB),the patients were classified into M_(2)type(3 cases),M_(4)type(9 cases),and M_(5)type(6 cases).According to National Comprehensive Cancer Network(NCCN)guidelines,the patients with AML were classified into 3 cytogenetic prognostic groups:low risk(6 cases),intermediate risk(8 cases)and high risk(4 cases),among whom,11 patients were in the first complete remission(CR 1)before the transplantation and 7 patients in the second complete remission(CR 2)before the transplantation.Hematopoietic stem cells of all the patients were derived from peripheral blood,among whom 18 cases were mobilized by chemotherapy drugs+granulocyte colony-stimulating factor(G-CSF),and 2 cases were mobilized by plerixafor in the second time due to the insufficient quantity collected in the first time.The median count number of infused CD34^(+)cells was 4.05×10^(6)/kg(1.87×10^(6)-27.40×10^(6)/kg)and the median count number of infused mononuclear cells was 14.48×108/kg(4.07×108-24.74×108/kg)in the 18 cases.Results The median time of neutrophil engraftment in the 18 cases was 10(9-13)days,and their median time of platelet engraftment was 15(10-19)days.The 3-year overall survival rate and leukemia-free survival rate were 73.00%and 72.00%,respectively.The relapse rate was 33.33%in the patients with BuCy-based conditioning regimen and 12.50%in the patients with BuMel-based conditioning regimen.All the 18 patients had different gastrointestinal reactions.In the 6 patients with BuCy-based conditioning regimen,the adverse reactions outside the bloodstream includedⅠ-Ⅱdiarrhea,palpitation,chest tightness
作者
张敏
刘玲
姜文娜
刘焕平
陈璐璐
张颢
ZHANG Min;LIU Ling;JIANG Wen-na(Department of Hematology,Affiliated Hospital of Jining Medical University,Shandong 272007,China)
出处
《中国临床新医学》
2023年第11期1115-1120,共6页
CHINESE JOURNAL OF NEW CLINICAL MEDICINE
基金
山东省自然科学基金项目(编号:ZR2021MH320)。
关键词
急性髓系白血病
自体造血干细胞
移植
Acute myeloid leukemia(AML)
Autologous hematopoietic stem cell
Transplantation
