11例白血病异基因造血干细胞移植后复发行二次移植的临床研究

刘夫红; 薛松; 张永平; 黄文秋; 王静波

doi:10.13201/j.issn.1004-2806.2021.03.006

11例白血病异基因造血干细胞移植后复发行二次移植的临床研究

- 航天中心医院血液科(北京, 100049)
基金项目:
首都临床特色应用研究与成果推广(北京市科技计划项目)(No:Z171100001017103)

详细信息

通讯作者: 王静波,E-mail:wangjingbo@asch.net.cn

中图分类号: R457.7

收稿日期: 2020-11-23

Clinical study of second transplantation of 11 leukemia cases with recurrence after allogeneic hematopoietic stem cell transplantation

- Department of Hematology, Aerospace Center Hospital, Beijing, 100049, China

More Information

Corresponding author: WANG Jingbo, E-mail: wangjingbo@asch.net.cn

Received Date: 23 November 2020

摘要

摘要: 目的:研究第二次异基因造血干细胞移植(allo-HSCT)治疗白血病的疗效,探讨如何提高二次移植的成功率。方法:总结本院2012—2019年11例因allo-HSCT后复发行第二次allo-HSCT(更换供者)的急性白血病患者的临床资料,回顾性分析其治疗过程及转归,并分析二次移植前患者的缓解状态、供者选择、预处理方案等对总生存、无病生存、复发死亡率、移植相关死亡率等移植疗效的影响。结果:11例患者在二次移植后均获得早期缓解,随访至今,2例患者无病存活,存活时间分别为9个月、18.4个月,2例患者因移植后合并症(血栓性微血管病/肺部移植物抗宿主病)死亡,7例患者因复发死亡。其中早期死亡(移植后3个月内)2例,二次移植至死亡中位时间为9个月(2~48个月)。11例患者二次移植后中位总生存期11个月(2~18.4个月),中位无病生存期6个月(1~18.4个月),复发死亡率63.6%,移植相关死亡率18.2%。结论:二次移植是治疗allo-HSCT后复发的一种有效手段,部分患者可获得长久无病生存,但二次移植合并症多、复发率高,需要慎重考虑,强化预处理、更换供者、缓解期行二次移植被认为是提高二次移植疗效的可能手段。
- 二次移植 /
- 异基因造血干细胞移植 /
- 移植后复发 /
- 急性白血病
Abstract: Objective: To study the efficacy of the second allogeneic hematopoietic stem cell transplantation(allo-HSCT) in the treatment of recurrent leukemia after the first allo-HSCT, and to explore how to improve the success rate of the second transplantation.Methods: The clinical data of 11 patients with acute leukemia who received the second allo-HSCT(donor change) in our hospital from 2012 to 2019 due to the recurrence after the first allo-HSCT were summarized. The treatment process and outcome were retrospectively analyzed. The effects of remission status, donor selection and preconditioning regimen of the patients before the second transplantation on the transplantation efficacy, such as overall survival, progression-free survival, recurrence and death, and transplant-related mortality were also analyzed.Results: The 11 patients obtained early remission after the second transplantation. The follow-up so far showed that, 2 patients had survived without progression for 9 months and 18.4 months respectively, 2 patients had died of post-transplant complications(thrombotic microangiopathy/pulmonary graft versus host disease), and 7 patients had died of recurrence. Among them, 2 cases died early(within 3 months after transplantation), and the median time from the second transplantation to death was 9 months(2 months to 48 months). The median overall survival time of the 11 patients after the second transplantation was 11 months(2 months to 18.4 months), the median progression-free survival time was 6 months(1 month to 18.4 months), the recurrence and death rate was 63.6%, and the transplant-related mortality was 18.2%.Conclusion: Second transplantation is an effective method to treat the recurrence after allo-HSCT. Some patients can obtain long-term progression-free survival. However, the second transplantation will lead to many complications and bears a high recurrence rate, requiring careful consideration. Enhanced preconditioning, donor change, and second transplantation in the remission period are considered as possible means to improve the efficacy of second transplantation.
- second transplantation /
- allogeneic hematopoietic stem cell transplantation /
- recurrence after transplantation /
- acute leukemia

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