[1]杨露欣,谭亚敏,施继敏,等.高危急性白血病异基因造血干细胞移植后行预防性改良供者淋巴细胞输注的疗效及安全性分析[J].第三军医大学学报,2019,41(23):2267-2271.
 YANG Luxin,TAN Yamin,SHI Jimin,et al.Efficacy and safety of prophylactic modified donor lymphocyte infusion following allogeneic hematopoietic stem cell transplantation for high-risk acute leukemia[J].J Third Mil Med Univ,2019,41(23):2267-2271.
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高危急性白血病异基因造血干细胞移植后行预防性改良供者淋巴细胞输注的疗效及安全性分析(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第23期
页码:
2267-2271
栏目:
专题报道
出版日期:
2019-12-15

文章信息/Info

Title:
Efficacy and safety of prophylactic modified donor lymphocyte infusion following allogeneic hematopoietic stem cell transplantation for high-risk acute leukemia
作者:
杨露欣谭亚敏施继敏赵妍敏余建胡永仙来晓瑜黄河罗依
310003 杭州,浙江大学医学院附属第一医院骨髓移植中心
Author(s):
YANG Luxin TAN Yamin SHI Jimin ZHAO Yanmin YU Jian HU Yongxian LAI Xiaoyu HUANG He LUO Yi

Bone Marrow Transplantation Center, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310003, China

关键词:
异基因造血干细胞移植供者淋巴细胞输注急性白血病移植物抗宿主病
Keywords:
allogeneic hematopoietic stem cell transplantation donor lymphocyte infusion acute leukemia graft versus host disease
分类号:
R181.32; R730.59; R733.71
文献标志码:
A
摘要:

目的探讨异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)后,早期预防性改良供者淋巴细胞输注(donor lymphocyte infusion,DLI)预防高危急性白血病复发的疗效及安全性。方法回顾性分析2013年1月至2017年6月在本中心行allo-HSCT 并接受预防性改良DLI的62例高危急性白血病患者的临床资料。患者均在原发病完全缓解(complete remission,CR)状态下输注由重组人粒细胞集落刺激因子动员的外周血干细胞并联合短程小剂量环孢素预防移植物抗宿主病(graft versus host disease,GVHD)。结果62例高危急性白血病患者在距移植中位时间为105.5(59~355)d接受预防性DLI,中位CD3细胞量为3.95(0.4~7.6)×107/kg。移植后中位随访33.2(3.4~64.7)个月, 41例患者获得长期无病生存,其中17例患者复发;共21例患者死亡。3年总体生存率(overall survival,OS)、无白血病生存率(leukemia-free survival, LFS)分别为69.6%及63.6%。3年累积复发率及无复发死亡率分别为29.7%及6.7%。Ⅱ~Ⅳ度及Ⅲ~Ⅳ度急性移植物抗宿主病(aGVHD)的100 d累积发生率分别为22.6%和11.3%。3年中重度慢性移植物抗宿主病(cGVHD)的累积发生率为32.9%。3年无复发无排异生存率(GVHD-free and relapse-free survival,GRFS)为31.7%。结论高危急性白血病异基因造血干细胞移植后,早期行改良供者淋巴细胞输注能有效预防复发,且不增加GVHD发生率及治疗相关死亡率。
 

Abstract:

ObjectiveTo evaluate the efficacy and safety of prophylactic modified donor lymphocyte infusion (DLI) early after allogeneic hematopoietic stem cell transplantation (allo-HSCT) to prevent the relapse of patients with high-risk acute leukemia. MethodsWe retrospectively analyzed the clinical data of 62 patients with high-risk acute leukemia, who underwent allo-HSCT and received prophylactic modified DLI in our center between January 1, 2013 and June 30, 2017. All the patients received infusion of recombinant human colony-stimulating factor-primed peripheral blood progenitor cells and short-term immunosuppressant therapy with low-dose closporine A in complete remission (CR) to prevent graft versus host disease (GVHD). ResultsAt a median time of 105.5 (59~355) days after the transplantation, the 62 patients received prophylactic modified DLI of a median of 3.95 (0.4~7.6)×107/kg CD3+ cells. The patients were followed up for 3.4~64.7 months (median 33.2 months), during which 41 patients were alive with CR, 17 had relapses, and 21 died. The 3-year probability of overall survival (OS) and leukemia-free survival (LFS) was 69.6% and 63.6% and the 3-year cumulative incidences of relapse and non-relapse mortality (NRM) were 29.7% and 6.7% in these patients, respectively. The incidences of grades Ⅱ~Ⅳ and Ⅲ~Ⅳ acute GVHD at 100 d after DLI were 22.6% and 11.3%, respectively, and the 3-year cumulative incidence of moderate and severe chronic GVHD was 32.9%; the 3-year cumulative GVHD-free and relapse-free survival (GRFS) was 31.7% in these patients. ConclusionIn patients with high-risk acute leukemia, prophylactic modified DLI early after allo-HSCT is effective for preventing relapse without increasing the incidences of GVHD morbidity or NRM.

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更新日期/Last Update: 2019-12-09