Objective: To compare the outcomes of adult patients with acute lymphoblastic leukemia (ALL) who underwent autologous hematopoietic stem cell transplantation (auto-HSCT) and allogeneic hematopoietic stem cell transplantation (allo-HSCT).
Methods: From Jan 2007 to Dec 2010, 106 adult ALL patients were retrospectively divided into two groups, 50 in auto-HSCT group and 56 in allo-HSCT group. Auto-HSCT group included 21 patients with high-risk, 46 patients in CR1 and 4 cases in CR2. All the 50 patients had negative minimal residual disease (MRD) prior to HSCT. Allo-HSCT group included 44 patients with high risk, 51 patients in CR1 and 5 cases in CR2, 15 patients with positive MRD before allo-HSCT. response, regulatory T cells (Treg), cytokines levels and treatment-related adverse effects were observed.
Results: Of the total 106 patients, 29 patients relapsed at a medium follow-up of 22.9(0.8-63.3) months. The 3-year cumulative relapse rate (RR) was (29.9±8.0) % in auto-HSCT group and (32.7±6.8) % in allo-HSCT group. There were no significant differences in RR and overall survival (OS) between auto-HSCT and allo-HSCT groups, even of stratified risk groups. In standard risk group, 3-year OS was (77.1±13.2) % in auto-HSCT group and (90.9±8.7) % in allo-HSCT group (P=0.739). In high-risk group, 3-year OS was (68.7±10.8) % after auto-HSCT and (45.2±8.5) % after allo-HSCT (P=0.094).
Conclusion: Due to acceptable RR and OS, adult ALL patients with no MRD before HSCT showed favorable survival. Auto-HSCT may be a considerable choice for adult ALL patients with negative MRD when lacking of donors for allo-HSCT.
目的: 对比分析成人急性淋巴细胞白血病(ALL)自体造血干细胞移植(auto-HSCT)和异基因造血干细胞移植(allo-HSCT)疗效差异。
方法: 研究纳入2007年1月至2010年12月进行造血干细胞移植(HSCT)的106例成人ALL患者，其中auto-HSCT 50例，首次完全缓解(CR1)46例，第2次CR(CR2)4例，高危组21例，移植前检测微小残留病(MRD)均阴性；allo-HSCT患者56例，CR151例，CR25例，高危组44例，移植前14例MRD阳性。
结果: 106例患者移植后中位随访22.9(0.8~63.3)个月，29例血液学复发。其中auto-HSCT、allo-HSCT患者3年累积复发率(RR)分别为(29.9±8.0)%和（32.7±6.8）%（P=0.402）。标危组患者auto-HSCT和allo-HSCT后RR差异无统计学意义（P=0.554），高危组患者auto-HSCT和allo-HSCT后RR差异亦无统计学意义（P=0.967）。allo-HSCT患者2年累积非复发死亡率(NRM)[(22.3±6.0)%]显著高于auto-HSCT患者(0)(P=0.001)。标危组患者auto-HSCT和allo-HSCT后3年总生存(OS)率分别为（77.1±13.2）%和(90.9±8.7)%（P=0.739）。高危组患者auto-HSCT和allo-HSCT后3年OS率分别为（68.7±10.8）%和(45.2±8.5)%(P=0.094)。
结论: 成人ALL患者auto-HSCT和allo-HSCT同样有效，如果患者MRD持续阴性，auto-HSCT可成为allo-HSCT的有效替代治疗手段。