输注的CD34+细胞剂量可预测首次完全缓解时接受来自匹配同胞供体的异基因骨髓移植的急性髓性白血病患者的长期生存情况。

Infused CD34+ cell dose predicts long-term survival in acute myelogenous leukemia patients who received allogeneic bone marrow transplantation from matched sibling donors in first complete remission.

作者信息

Lee Se-Hoon, Lee Mark H, Lee Je-Hwan, Min Yoo Hong, Lee Kyoo-Hyung, Cheong June-Won, Lee Jeeyun, Park Keon Woo, Kang Jung Hun, Kim Kihyun, Kim Won Seog, Jung Chul Won, Choi Seong-Jun, Lee Jung-Hee, Park Keunchil

机构信息

Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

出版信息

Biol Blood Marrow Transplant. 2005 Feb;11(2):122-8. doi: 10.1016/j.bbmt.2004.11.018.

DOI:10.1016/j.bbmt.2004.11.018

PMID:15682073

Abstract

Allogeneic stem cell transplantation (ASCT) has improved the outcome of acute myelogenous leukemia (AML). To further improve the treatment outcome of ASCT in AML, finding a modifiable prognostic factor is mandatory. We evaluated the effect of CD34(+) cell dose on survival in allogeneic bone marrow transplantation (BMT) from HLA-matched sibling donors for AML patients in first complete remission (CR1). The 99 patients included in our analysis were classified into high CD34(+) cell dose group (CD34(+) cells > or = 2.5 x 10(6)/kg) and low CD34(+) cell dose group (CD34(+) cells < 2.5 x 10(6)/kg). The high CD34(+) cell dose patients had better overall survival (5-year overall survival rate, 75% +/- 6% vs 52% +/- 9%; P = .01) and leukemia-free survival (5-year leukemia-free survival rate, 70% +/- 6% vs 44% +/- 9%; P = .04). CD34(+) cell dose was the only independent prognostic factor in overall survival and leukemia-free survival. The high CD34(+) cell dose group had a lower relapse incidence with a borderline statistical significance (5-year relapse rate, 27% +/- 6% vs 50% +/- 10%; P = .09). There were no differences in the engraftment of neutrophil and platelet, grade II-IV acute graft-versus-host disease (GVHD), extensive-stage chronic GVHD, and transplant-related mortality between the high and low CD34(+) cell dose groups. We confirmed that high CD34(+) cell dose favorably affects the outcomes in allogeneic BMT for AML. The effort to attain a high CD34(+) cell dose should be pursued during bone marrow harvest in allogeneic BMT for AML in CR1.

摘要

异基因干细胞移植（ASCT）改善了急性髓系白血病（AML）的治疗结果。为进一步提高AML患者ASCT的治疗效果，寻找一个可改变的预后因素至关重要。我们评估了CD34(+)细胞剂量对首次完全缓解（CR1）的AML患者接受来自HLA匹配同胞供者的异基因骨髓移植（BMT）后生存情况的影响。我们分析的99例患者被分为高CD34(+)细胞剂量组（CD34(+)细胞≥2.5×10(6)/kg）和低CD34(+)细胞剂量组（CD34(+)细胞＜2.5×10(6)/kg）。高CD34(+)细胞剂量组患者的总生存期更好（5年总生存率，75%±6%对52%±9%；P = 0.01），无白血病生存期也更好（5年无白血病生存率，70%±6%对44%±9%；P = 0.04）。CD34(+)细胞剂量是总生存期和无白血病生存期唯一的独立预后因素。高CD34(+)细胞剂量组的复发率较低，具有临界统计学意义（5年复发率，27%±6%对50%±10%；P = 0.09）。高、低CD34(+)细胞剂量组在中性粒细胞和血小板植入、II - IV级急性移植物抗宿主病（GVHD）、广泛期慢性GVHD以及移植相关死亡率方面无差异。我们证实，高CD34(+)细胞剂量对AML异基因BMT的治疗结果有积极影响。对于处于CR1的AML患者进行异基因BMT时，在骨髓采集过程中应努力获得高CD34(+)细胞剂量。