[1]蔺诗佳,赵伟,陈婷,等.二次移植治疗异基因造血干细胞移植后复发急性髓系白血病5例临床观察[J].第三军医大学学报,2019,41(23):2301-2306.
 LIN Shijia,ZHAO Wei,CHEN Ting,et al.Second allogeneic hematopoietic stem cell transplantation in treatment of relapsed acute myeloid leukemia: clinical report of 5 cases[J].J Third Mil Med Univ,2019,41(23):2301-2306.
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二次移植治疗异基因造血干细胞移植后复发急性髓系白血病5例临床观察(/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:
2301-2306
栏目:
专题报道
出版日期:
2019-12-15

文章信息/Info

Title:
Second allogeneic hematopoietic stem cell transplantation in treatment of relapsed acute myeloid leukemia: clinical report of 5 cases
作者:
蔺诗佳赵伟陈婷姚浛向茜茜饶军张诚刘耀高蕾高力张曦孔佩艳
400037 重庆,陆军军医大学(第三军医大学)第二附属医院血液病医学中心,全军血液科中心,创伤、烧伤与复合伤研究国家重点实验室
Author(s):
LIN Shijia ZHAO Wei CHEN Ting YAO Han XIANG Xixi RAO Jun ZHANG Cheng LIU Yao GAO Lei GAO Li ZHANG Xi KONG Peiyan

State Key Laboratory of Trauma, Burns and Combined Injury, Medical Center of Hematology, PLA Center for Hematology, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China

关键词:
急性髓系白血病复发二次移植异基因造血干细胞移植
Keywords:
acute myeloid leukemia relapse second transplantation allogenic hematopoietic stem cell transplantation
分类号:
R617; R730.59; R733.71
文献标志码:
A
摘要:

目的探讨第2次异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)治疗异基因造血干细胞移植后复发的急性髓系白血病患者的临床疗效。方法收集本院2012年1月至2019年6月在allo-HSCT后复发的急性髓系白血病患者5例,经再诱导后(达到CR2-MRD阴性3例;CR2-MRD阳性1例,NR 1例)行清髓性预处理第2次异基因造血干细胞移植(allo-HSCT2),回顾性分析其治疗过程及转归,并分析allo-HSCT2前患者的缓解状态、供者选择、预处理方案等对移植相关并发症、复发死亡(recurrence and death, RM)、移植相关死亡率(transplant-related mortality, TRM)及移植疗效的影响。结果随访至2019年6月30日,5例患者均达到完全供者植入,3例患者17个月内无复发,2例患者allo-HSCT2后因复发死亡。1例发生Ⅰ度急性移植物抗宿主病(acute graft versus host disease,aGVHD)及肺部重度慢性移植物抗宿主病(chronic graft versus host disease,cGVHD)的患者于allo-HSCT2后20个月因呼吸衰竭死亡,其余4例患者未观察到严重的移植相关并发症。allo-HSCT2前骨髓达到完全缓解且微小残留病(minimal residual disease,MRD)阴性的患者预后较好;行二次allo-HSCT与行一次allo-HSCT相比,未增加患者的TRM;对接受第2次异基因造血干细胞移植的患者而言,单倍体移植的移植物抗白血病(graft versus leukemia, GVL)效应与全相合移植相比没有明显的优势。结论第2次异基因造血干细胞移植是治疗异基因造血干细胞移植后复发的急性髓系白血病患者的有效手段。

Abstract:

ObjectiveTo investigate the clinical efficacy and its influencing factors of second allogeneic hematopoietic stem cell transplantation (allo-HSCT2) in acute myeloid leukemia (AML) patients who have relapsed after the first allogeneic transplantation. MethodsClinical data of 5 patients with refractory/relapsed AML who had relapsed after allo-HSCT in our medical center from January 2012 to October 2018 were collected in this study. After re-induction (CR2-MRD- was achieved in 3 cases, CR2-MRD+ in 1 case, and NR in 1 case) and myeloablative pretreatment, allo-HSCT2 was conducted to all of them. The clinical process and outcome of these cases were analyzed, and the possible effects of alleviation status, donor selection, pretreatment protocol of the allo-HSCT2 patients before transplantation on the complications, recurrence and death (RM), transplant-related mortality (TRM), and transplantation outcome were also investigated. ResultsUntil the 5 patients were followed up to June 30, 2019, all of them achieved complete donor implantation. Three of them had no relapse within 17 months, and 1 patient developed acute graft versus host disease (aGVHD) grade Ⅰ and chronic graft versus host disease (cGVHD) as severe lung disease, and hence deceased due to respiratory failure in 20 months after the allo-HSCT2. No serious HSCT-related complications were observed in the other 4 patients.  The patients with complete remission of allo-HSCT2 with a negative status of (minimal residual disease, MRD), proved to have a better prognosis. Second allo-HSCT did not increase TRM compared with one-time allo-HSCT. For the patients receiving allo-HSCT2, the GVL effect of haploid transplantation had no significant advantage against full-matched HSCT. ConclusionAllo-HSCT2 is an effective therapy for AML patients who relapsed after the first allo-HSCT.

参考文献/References:

[1]BEJANYAN N, WEISDORF D J, LOGAN B R, et al. Survival of patients with acute myeloid leukemia relapsing after allogeneic hematopoietic cell transplantation: a center for international blood and marrow transplant research study[J]. Biol Blood Marrow Transplant, 2015, 21(3): 454-459. DOI:10.1016/j.bbmt.2014.11.007.
[2]TAKAMI A. Hematopoietic stem cell transplantation for acute myeloid leukemia[J]. Int J Hematol, 2018, 107(5): 513-518. DOI:10.1007/s12185-018-2412-8.
[3]DUVAL M, KLEIN J P, HE W S, et al. Hematopoietic stem-cell transplantation for acute leukemia in relapse or primary induction failure[J]. J Clin Oncol, 2010, 28(23): 3730-3738. DOI:10.1200/JCO.2010.28.8852.
[4]PARK S S, KIM H J, MIN K I, et al. Prognostic prediction model for second allogeneic stem-cell transplantation in patients with relapsed acute myeloid leukemia: single-center report[J]. Clin Lymphoma Myeloma Leuk, 2018, 18(4): e167-e182. DOI:10.1016/j.clml.2018.02.009.
[5]YAFOUR N, BECKERICH F, BULABOIS C E, et al. How to prevent relapse after allogeneic hematopoietic stem cell transplantation in patients with acute leukemia and myelodysplastic syndrome[J]. Curr Res Transl Med, 2017, 65(2): 65-69. DOI:10.1016/j.retram.2017.06.001.
[6]YAN C H, LIU Q F, WU D P, et al. Prophylactic donor lymphocyte infusion (DLI) followed by minimal residual disease and graft-versus-host disease-guided multiple DLIs could improve outcomes after allogeneic hematopoietic stem cell transplantation in patients with refractory/relapsed acute leukemia[J]. Biol Blood Marrow Transplant, 2017, 23(8): 1311-1319. DOI:10.1016/j.bbmt.2017.04.028.
[7]WEINKOVE R, ANCELET L R, GIBBINS J D, et al. An adjuvanted whole cell vaccine as post-remission immunotherapy for acute leukemia[J]. Oncoimmunology, 2015, 4(4): e995568. DOI:10.1080/2162402X.2014.995568.
[8]PORTER D L, ALYEA E P, ANTIN J H, et al. NCI first international workshop on the biology, prevention, and treatment of relapse after allogeneic hematopoietic stem cell transplantation: report from the committee on treatment of relapse after allogeneic hematopoietic stem cell transplantation[J]. Biol Blood Marrow Transplant, 2010, 16(11):1467-1503. DOI: 10.1016/j.bbmt.2010.08.001.
[9]THAKAR M S, FORMAN S J. ASH evidence-based guidelines: is there a role for second allogeneic transplant after relapse?[J]. Hematology Am Soc Hematol Educ Program, 2009:414-418. DOI: 10.1182/asheducation-2009.1.414.
[10]LEUNG A Y, TSE E, HWANG Y Y, et al. Primary treatment of leukemia relapses after allogeneic hematopoietic stem cell transplantation with reduced-intensity conditioning second transplantation from the original donor[J]. Am J Hematol, 2013,88(6):485-491. DOI: 10.1002/ajh.23439.
[11]SPITZER B, PERALES M A, KERNAN N A, et al. Second allogeneic stem cell transplantation for acute leukemia using a chemotherapy-only cytoreduction with clofarabine, melphalan, and thiotepa[J]. Biol Blood Marrow Transplant, 2016, 22(8): 1449-1454. DOI:10.1016/j.bbmt.2016.05.001.
[12]CHRISTOPEIT M, KUSS O, FINKE J, et al. Second allograft for hematologic relapse of acute leukemia after first allogeneic stem-cell transplantation from related and unrelated donors: the role of donor change[J]. J Clin Oncol, 2013, 31(26): 3259-3271. DOI:10.1200/JCO.2012.44.7961.
[13]TACHIBANA T, MATSUMOTO K, TANAKA M, et al. Outcome and prognostic factors among patients who underwent a second transplantation for disease relapse post the first allogeneic cell transplantation[J]. Leuk Lymphoma, 2017, 58(6): 1403-1411. DOI:10.1080/10428194.2016.1243678.
[14]TALLIS E, BORTHAKUR G. Novel treatments for relapsed/refractory acute myeloid leukemia with FLT3 mutations[J]. Expert Rev Hematol, 2019, 12(8): 621-640. DOI:10.1080/17474086.2019.1635882.
[15]DAVER N, SCHLENK R F, RUSSELL N H, et al. Targeting FLT3 mutations in AML: review of current knowledge and evidence[J]. Leukemia, 2019, 33(2): 299-312. DOI:10.1038/s41375-018-0357-9.
[16]STAUDT D, MURRAY H C, MCLACHLAN T, et al. Targeting oncogenic signaling in mutant FLT3 acute myeloid leukemia: the path to least resistance[J]. Int J Mol Sci, 2018, 19(10): E3198. DOI:10.3390/ijms19103198.
[17]GOOLEY T A, CHIEN J W, PERGAM S A, et al. Reduced mortality after allogeneic hematopoietic-cell transplantation[J]. N Engl J Med, 2010, 363(22): 2091-2101. DOI:10.1056/NEJMoa1004383.
[18]苏秀华,姚剑峰,张桂新,等.异基因造血干细胞移植治疗难治/复发急性髓系白血病的疗效及预后因素分析[J].中华血液学杂志,2017, 38(12): 1024-1030. DOI:10.3760/cma.j.issn. 0253-2727.2017.12.004.
SU X H, YAO J F, ZHANG G X, et al. Allogeneic hematopoietic stem cell transplantation for treatment of refractory and relapsed acute myeloid leukemia: outcomes and prognostic factors[J]. Chin J Hematol, 2017, 38(12): 1024-1030. DOI:10.3760/cma.j.issn. 0253-2727.2017.12.004.

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更新日期/Last Update: 2019-12-09