异基因造血干细胞移植对急性髓系白血病的疗效观察及生存预后影响因素分析

Therapeutic effect of allogeneic hematopoietic stem cell transplantation on acute myeloid leukemia and influencing factors of survival prognosis

  • 摘要: 目的 观察异基因造血干细胞移植(allo-HSCT)对急性髓系白血病(AML)的疗效,并分析生存预后的影响因素。方法 回顾性分析32例接受allo-HSCT治疗的AML患者的临床资料,观察患者造血重建情况、移植物抗宿主病(GVHD)发生情况、生存情况、复发情况和移植相关死亡(TRM)情况,并分析生存预后的影响因素。结果 32例接受allo-HSCT治疗的AML患者均实现粒系重建,重建时间为10~26 d, 中位时间为11.0 d; 30例患者实现巨核系重建,重建时间范围为10~54 d, 中位时间为13.5 d。可评估的30例患者中, 10例患者发生急性GVHD(发生率为33.33%), 10例患者发生慢性GVHD(发生率为33.33%)。截至2023年5月31日,随访时间范围为2~28个月,中位随访时间为14.5个月; 30例患者中, 28例患者存活(25例处于无病生存状态), 2例患者死亡。多因素Cox回归分析结果显示,年龄>35岁(P=0.035, HR=2.021)、移植后复发(P=0.021, HR=2.546)是影响患者生存预后的独立危险因素。30例患者中, 5例患者复发,复发时间范围为6~24个月,中位时间为9.0个月。5例复发患者中, 2例患者死亡(非TRM)。结论 allo-HSCT是治疗AML的有效方法,年龄>35岁、移植后复发是影响患者生存预后的独立危险因素。

     

    Abstract: Objective To observe the therapeutic effect of allogeneic hematopoietic stem cell transplantation (allo-HSCT) on acute myeloid leukemia (AML) and analyze the influencing factors of survival prognosis. Methods The clinical data of 32 AML patients who underwent allo-HSCT treatment were retrospectively analyzed. The hematopoietic reconstitution, occurrence of graft-versus-host disease (GVHD), survival status, recurrence, and transplantation-related mortality (TRM) of patients were observed, and the influencing factors of survival prognosis were analyzed. Results All 32 AML patients who underwent allo-HSCT achieved granulocyte reconstitution, with a time range of 10 to 26 days and a median time of 11.0 days. Granulocyte-macrophage lineage reconstitution was achieved in 30 patients, with a time range of 10 to 54 days and a median time of 13.5 days. Among the 30 evaluable patients, 10 developed acute GVHD (with incidence rate of 33.33%) and 10 developed chronic GVHD (incidence rate of 33.33%). Up to May 31, 2023, the follow-up time ranged from 2 to 28 months, with a median follow-up time of 14.5 months. Of the 30 patients, 28 survived (25 patients were in disease-free survival status), and 2 died. Multivariate Cox regression analysis showed that age>35 years (P=0.035, HR=2.021) and recurrence after transplantation (P=0.021, HR=2.546) were independent risk factors of patients' survival prognosis. Among 30 patients, 5 relapsed, with a time range of 6 to 24 months and a median time of 9.0 months. Of 5 relapsed patients, 2 died (non-TRM). Conclusion Allo-HSCT is an effective treatment for AML. Age>35 years and recurrence after transplantation are independent risk factors of patients' survival prognosis.

     

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