Objective: To compare the efficacy of activated autologous bone marrow and peripheral blood hematopoietic stem cell transplantation (Auto-HSCT) and matched sibling donor allogeneic hematopoietic stem cell transplantation (MSD-HSCT) for the first complete remission of adult acute myeloid leukemia (AML-CR1).
Methods: For 86 adult patients with first complete remission of AML who underwent auto-HSCT (41 cases) and MSD-HSCT (45 cases) in our hospital from June 2012 to June 2020, the patients were treated with modified MAC ［Malflane 160 mg/(m2·d), -3 days, Ara-C 2 g/(m2·2), -3 days 21∶00, -2 days 9∶00, CTX 60 mg/(kg·d),-3 d, -2 d］, the stem cells were activated by IL-2 (1 000 U/ mL), IFN-α (100 U/ mL) and IFN-γ (100 U/ml). The overall survival (OS), leukemia free survival (LFS), cumulative incidence of recurrence (CIR) and non-recurrence mortality (NRM) of patients with different types of transplantation were compared.
Results: The 3-year OS rates of Auto-HSCT group and MSD-HSCT group were 75% and 69.5%, and the 3-year LFS rates were 70.6% and 82.4%, respectively. There was no statisticaly significant difference in the 3-year OS rates of low risk, medium risk and high risk patients in the Auto-HSCT and MSD-HSCT group (90.2% vs 87.5%, 68.4% vs 68.8%, 28.6% vs 53.3%), the LFS rates of low risk, medium risk and high risk patients in the auto-HSCT and MSD-HSCT group were 90.2% and 87.5%(P=0.838), 71.8% and 91.7%(P=0.184), 0 and 67.5%(P=0.027), respectively. The NRM of Auto-HSCT and MSD-HSCT group were 4.9% and 20% (P=0.036), and CIR were 24.4% and 13.3% (P=0.188). Univariate analysis showed that the survival time of patients was significantly correlated with the number of CR courses and disease risk stratification (P=0.005, P=0.000). Cox multivariate analysis showed that disease risk stratification was an independent risk factor affecting OS (P=0.001).
Conclusion: For adult patients with primary AML-CR1, Auto-HSCT is safe and effective. In the absence of sibling donor, Auto-HSCT can be regarded as an effective post-remission treatment for patients with intermediate risk AML-CR1.
题目: 活化自体造血干细胞移植治疗急性髓系白血病疗效分析.
目的: 比较活化自体骨髓和外周血造血干细胞移植（Auto-HSCT）与同胞全相合异基因造血干细胞移植（MSD-HSCT）治疗首次完全缓解成人急性髓系白血病（AML-CR1）的疗效.
方法: 回顾性分析2012年6月至2020年6月于山西白求恩医院采用改良MAC预处理［马法兰 160 mg/(m2·d)，-3 d，Ara-C 2 g/(m2·2次)，-3 d 21∶00，-2 d 9∶00，CTX 60 mg/(kg·d)，-3 d，-2 d］，回输经IL-2（1 000 U/ml）、IFN-α（100 U/ml）、IFN-γ（100 U/ml）活化处理后干细胞，行Auto-HSCT（41例） 及MSD-HSCT（45例）的86例首次完全缓解成人AML患者的临床特征，比较不同移植方式患者的总生存（OS）率、无白血病生存（LFS）率、累积复发率（CIR）及非复发死亡率（NRM）.
结果: Auto-HSCT组与MSD-HSCT组的3年OS率分别为75%、69.5%，3年LFS 分别为70.6%、82.4%，比较差异均无统计学意义（P>0.05）。两组患者中遗传学低危、中危、高危组3年OS率比较均无统计学差异（90.2% vs 87.5%， 68.4% vs 68.8%， 28.6% vs 53.3%， P>0.05）；行Auto-HSCT和MSD-HSCT患者低危组的LFS率分别为 90.2%、87.5%（P＝0.838），中危组为71.8%、91.7%（P＝0.184），高危组为0、67.5%（P＝0.027）。Auto-HSCT与MSD-HSCT组的NRM分别为4.9%、20%（P=0.036），CIR分别为24.4%、13.3%（P=0.188）。单因素分析显示，患者生存时间与CR疗程数及疾病危险度分层显著有关（P=0.005，P=0.000）；Cox多因素分析显示，疾病危险度分层是影响患者OS的独立危险因素（P=0.001）.
结论: 对于成人原发性AML-CR1患者，行Auto-HSCT治疗安全、有效；中危AML CR1患者在无同胞相合供者时，Auto-HSCT是一种有效的缓解后治疗方法.
Keywords: allogeneic hematopoietic stem cell transplantation; autologous hematopoietic stem cell transplantation; curative effect; improved MAC pretreatment.