Lyu M N, Jiang E L, He Y, Yang D L, Ma Q L, Pang A M, Zhai W H, Wei J L, Huang Y, Zhang G X, Zhang R L, Feng S Z, Han M Z
Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China.
Zhonghua Xue Ye Xue Za Zhi. 2020 May 14;41(5):373-378. doi: 10.3760/cma.j.issn.0253-2727.2020.05.003.
To compare the efficacy of autologous HSCT (auto-HSCT) with matched sibling donor (MSD) HSCT in Ph(+) ALL and provide a basis for the choice of transplantation method. We retrospectively investigated the outcomes of 78 adult patients with Ph(+) ALL who underwent auto-HSCT (=31) and MSD-HSCT (=47) in Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, from January 2008 to December 2017. The overall survival (OS) rate, leukemia-free survival (LFS) rate, cumulative incidence of relapse (CIR) rate, nonrelapse mortality (NRM) rate, and the impact of achievement of complete molecular response (CMR) within 3 months and sustaining CMR up to transplantation (s3CMR) on transplantation method were explored. The median time of neutrophil and platelet reconstitution in auto-HSCT and MSD-HSCT groups were 12 (10-29) days 14 (11-24) days (=0.006) and 17.5 (10-62) days 7 (10-33) days (=0.794) , respectively. In the MSD-HSCT group, the incidence of Ⅱ-Ⅳ and Ⅲ-Ⅳ acute graft-versus-host disease (GVHD) was 27.7% (13/47) and 8.5% (4/47) , respectively. The incidence of limited and extensive chronic GVHD was 17.0% (8/47) and 12.8% (6/47) , respectively. The estimated CIR, NRM, LFS, and OS at 3 years were not significantly different between auto-HSCT and MSD-HSCT groups (>0.05) . For 44 patients who achieved s3CMR, 3-year OS[ (84.0±8.6) % (78.0±8.7) %, =0.612], LFS[ (70.3±10.3) % (68.2±10.1) %, =0.970], CIR[ (24.9±10.0) % (14.4±8.0) %, =0.286], and NRM[ (4.7±4.7) % (17.4±8.1) %, =0.209] of the auto-HSCT and MSD-HSCT groups were not significantly different. However, for 34 patients who did not reach s3CMR, 3-year cumulative relapse rate of patients in the auto-HSCT group was significantly higher than MSD-HSCT group[ (80.0±14.7) % (39.6±10.9) %, =0.057]. auto-HSCT with maintenance therapy after HSCT appears to be an attractive treatment option for patients with Ph(+) ALL especially for those with s3CMR maintained up to transplantation. For non-s3CMR patients, allogeneic transplantation may be more effective from lower relapse.
比较自体造血干细胞移植（auto-HSCT）与同胞全相合供者造血干细胞移植（MSD-HSCT）治疗Ph(+)急性淋巴细胞白血病（ALL）的疗效，为移植方式的选择提供依据。我们回顾性分析了2008年1月至2017年12月在中国医学科学院血液病医院接受auto-HSCT（n = 31）和MSD-HSCT（n = 47）的78例成年Ph(+) ALL患者的预后。探讨了总生存（OS）率、无白血病生存（LFS）率、累积复发率（CIR）、非复发死亡率（NRM），以及移植前3个月达到完全分子缓解（CMR）并维持CMR至移植（s3CMR）对移植方式的影响。auto-HSCT组和MSD-HSCT组中性粒细胞和血小板恢复的中位时间分别为12（10 - 29）天对14（11 - 24）天（P = 0.006）和17.5（10 - 62）天对7（10 - 33）天（P = 0.794）。在MSD-HSCT组中，Ⅱ-Ⅳ度和Ⅲ-Ⅳ度急性移植物抗宿主病（GVHD）的发生率分别为27.7%（13/47）和8.5%（4/47）。局限性和广泛性慢性GVHD的发生率分别为17.0%（8/47）和12.8%（6/47）。auto-HSCT组和MSD-HSCT组3年时的估计CIR、NRM、LFS和OS无显著差异（P>0.05）。对于44例达到s3CMR的患者，auto-HSCT组和MSD-HSCT组的3年OS[（84.0±8.6）%对（78.0±8.7）%，P = 0.612]、LFS[（70.3±10.3）%对（68.2±10.1）%，P = 0.970]、CIR[（24.9±l0.0）%对（14.4±8.0）%，P = 0.286]和NRM[（4.7±4.7）%对（17.4±8.1）%，P = 0.209]无显著差异。然而，对于34例未达到s3CMR的患者，auto-HSCT组患者的3年累积复发率显著高于MSD-HSCT组[（80.0±14.7）%对（39.6±10.9）%，P = 0.057]。auto-HSCT联合HSCT后维持治疗似乎是Ph(+) ALL患者尤其是那些移植前维持s3CMR患者的一种有吸引力的治疗选择。对于非s3CMR患者，异基因移植可能因较低复发率而更有效。
