相关供者与无关供者异基因造血干细胞移植治疗白血病的疗效比较

[A comparison of the therapeutic effects between related donor and unrelated donor allogeneic hematopoietic stem cell transplantation in treatment of leukemia].

作者信息

Yang Kai, Liu Qi-fa, Fan Zhi-ping, Sun Jing, Xu Dan, Wei Yong-qiang, Zhang Yu, Meng Fan-yi

机构信息

Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

出版信息

Zhonghua Nei Ke Za Zhi. 2007 Feb;46(2):135-9.

PMID:17445441

Abstract

OBJECTIVE

To compare the therapeutic effect for leukemia between related donor hematopoietic stem cell transplantation (RD-HSCT) and unrelated donor hematopoietic stem cell transplantation (URD-HSCT).

METHODS

115 patients received allo-HSCT, of whom 68 received RD-HSCT and 47 received URD-HSCT. All patients were HLA serologically matched. Total body irradiation plus cyclophosphamide was adopted in 56 cases and busulfan, Ara-C, cyclophosphamide conditioning regimen (modified BuCY) in 59 cases. T and B cell reconstitution at different time points was assayed with flow cytometer one year after transplantation. Graft versus host disease (GVHD) and early infection were observed after transplantation. The difference of haematopoietic and immunological reconstitution between the two groups were estimated with Independent-Samples T test. Kaplan-Meier survival analysis model was used to estimate the overall survival and the disease-free survival in the two groups.

RESULTS

The time in WBC>1.0x10(9)/L was (13.1+/-2.4) d and (16.3+/-3.0) d (P=0.003), the time in PLT>20x10(9)/L was (14.9+/-6.6) d and (20.2+/-7.3) d (P=0.042), respectively, RD-BMT and URD-BMT. The time with WBC>1.0x10(9)/L was (12.5+/-2.9) d and (13.1+/-4.1) d (P=0.488), the time with PLT>20x10(9)/L was (12.2+/-4.2) d and (15.7+/-7.1) d (P=0.020), respectively, in RD-PBSCT and URD-PBSCT. The reconstitution of CD4+CD3+ at 1st, 3rd, 6th, 9th, 12th month, CD45RA+CD4+ at 1st month and CD8+CD3+ at 3rd month was different significantly between RD-HSCT and URD-HSCT. The incidence of II-IV acute GVHD, chronic GVHD and lethality of GVHD was 45.5% and 52.3%, 45.3% and 63.2%, 6.1% and 15.9%, respectively, in RD-HSCT and URD-HSCT groups. The relapse rate was 18.2% and 11.4%, respectively, in RD-HSCT and URD-HSCT groups. The incidence of early infection was 42.4% and 47.7% (P=0.696), respectively, in RD-HSCT and URD-HSCT groups. The overall survival and the disease-free survival rates at three-year follow-up were (67.8+/-6.9)% and (61.6+/-7.7)% (P=0.133), (62.3+/-6.9)% and (56.8+/-7.9)% (P=0.177), respectively, in RD-HSCT and URD-HSCT groups.

CONCLUSION

The therapeutic effect for leukemia is proximate in RD-HSCT and URD-HSCT.

摘要

目的

比较亲缘供者造血干细胞移植（RD-HSCT）与非亲缘供者造血干细胞移植（URD-HSCT）治疗白血病的疗效。

方法

115例患者接受异基因造血干细胞移植，其中68例接受RD-HSCT，47例接受URD-HSCT。所有患者HLA血清学配型相合。56例采用全身照射加环磷酰胺预处理，59例采用白消安、阿糖胞苷、环磷酰胺预处理方案（改良BuCY）。移植后1年用流式细胞仪检测不同时间点的T和B淋巴细胞重建情况。观察移植后移植物抗宿主病（GVHD）及早期感染情况。两组造血及免疫重建差异采用独立样本t检验评估。采用Kaplan-Meier生存分析模型评估两组的总生存及无病生存情况。

结果

RD-HSCT组和URD-HSCT组白细胞>1.0×10⁹/L的时间分别为（13.1±2.4）天和（16.3±3.0）天（P=0.003），血小板>20×10⁹/L的时间分别为（14.9±6.6）天和（20.2±7.3）天（P=0.042）。RD-PBSCT组和URD-PBSCT组白细胞>1.0×10⁹/L的时间分别为（12.5±2.9）天和（13.1±4.1）天（P=0.488），血小板>20×10⁹/L的时间分别为（12.2±4.2）天和（15.7±7.1）天（P=0.020）。RD-HSCT组和URD-HSCT组在第1、3、6、9、12个月时CD4⁺CD3⁺、第1个月时CD45RA⁺CD4⁺及第3个月时CD8⁺CD3⁺的重建情况差异有统计学意义。RD-HSCT组和URD-HSCT组II-IV级急性GVHD、慢性GVHD及GVHD致死率分别为45.5%和52.3%、45.3%和63.2%、6.1%和15.9%。RD-HSCT组和URD-HSCT组复发率分别为18.2%和11.4%。RD-HSCT组和URD-HSCT组早期感染发生率分别为42.4%和47.7%（P=0.696）。RD-HSCT组和URD-HSCT组三年随访总生存率及无病生存率分别为（67.8±6.9）%和（61.6±7.7）%（P=0.133）、（62.3±6.9）%和（56.8±7.9）%（P=0.177）。