Objective: To retrospectively analyze the efficacy and complications of our institution's modified nonmyeloablative allogeneic hematopoietic stem cell transplantation (NST) in treating intermediate-risk acute myeloid leukemia (AML) - first complete remission (CR1) and prognostic factors.
Methods: Clinical data of 50 intermediate-risk AML-CR1 patients who underwent matched related NST at the Fifth Medical Center of Chinese People's Liberation Army General Hospital from August 2004 to April 2021 were collected, the hematopoietic recovery, donor engraftment and complications were observed, and overall survival (OS) rate, leukemia-free survival (LFS) rate, treatment-related mortality (TRM), and cumulative relapse rate were calculated. Statistical analysis of factors affecting prognosis was also preformed.
Results: The median times for neutrophil and platelet recovery after transplantation were 10 (6-16) and 13 (6-33) days, respectively. One month after transplantation, 22 patients (44%) achieved full donor chimerism (FDC), and 22 patients (44%) achieved mixed chimerism (MC), among whom 18 cases gradually transited to FDC during 1-11 months, 4 cases maintained MC status. The overall incidence of acute graft-versus-host disease (aGVHD) was 36%, with a rate of 18% for grade II-IV aGVHD and a median onset time of 45 (20-70) days after transplantation. The overall incidence of chronic GVHD (cGVHD) was 34%, with 20% and 14% of patients having limited or extensive cGVHD, respectively. The incidence rates of infections, interstitial pneumonia, and hemorrhagic cystitis were 30%, 10%, and 16%, respectively. The 5-year OS rate, LFS rate, TRM, and cumulative relapse rate were 68%, 64%, 16%, and 20%, respectively. The increase of the number of CD34+ cells infused had shortened the recovery time for neutrophils and platelets (r =0.563, r =0.350). The number of CD34+ cells infused significantly influenced the occurrence of extensive cGVHD (OR =1.36, 95%CI : 1.06-1.84, P =0.024).
Conclusion: Modified NST is effective in treating intermediate-risk AML-CR1 patients, however, further expansion of sample size is needed to study prognostic factors.
题目: 非清髓性异基因造血干细胞移植治疗急性髓系白血病疗效及预后因素分析.
目的: 回顾性分析本中心改良非清髓性异基因造血干细胞移植治疗首次完全缓解期中危急性髓系白血病的疗效和并发症，并分析预后因素。.
方法: 收集2004年8月至2021年4月在解放军总医院第五医学中心进行亲缘HLA全相合非清髓性异基因造血干细胞移植的50例首次完全缓解期中危急性髓系白血病患者的临床资料，观察造血恢复、供体植入及并发症情况，计算总生存率、无白血病生存率、治疗相关死亡率、累积复发率，并对影响预后的因素进行统计学分析。.
结果: 移植后患者中性粒细胞和血小板中位恢复时间分别为10（6-16）和13（6-33）d。移植后1个月，22例（44%）患者形成完全供体嵌合体，22例（44%）形成混合嵌合体，其中18例在1-11个月逐渐转变为完全供体嵌合体，维持混合嵌合体状态4例。急性移植物抗宿主病总发生率为36%，其中II-IV级发生率为18%，中位发生时间为移植后45（20-70）d；慢性移植物抗宿主病总发生率为34%，其中局限型、广泛型分别为20%、14%；感染、间质性肺炎和出血性膀胱炎的发生率分别为30%、10%和16%。患者5年总生存率、无白血病生存率、治疗相关死亡率和累积复发率分别为68%、64%、16%和20%。回输CD34+细胞数量的增加缩短了中性粒细胞以及血小板恢复时间（r =0.563，r =0.350）；回输CD34+细胞数量能够显著影响广泛型慢性移植物抗宿主病的发生（OR =1.36，95%CI ：1.06-1.84，P =0.024）。.
结论: 改良非清髓性异基因造血干细胞移植用于治疗中危急性髓系白血病首次完全缓解患者疗效肯定，但尚需进一步扩大病例数对影响预后的因素进行深入研究。.
Keywords: acute myeloid leukemia; allogeneic hematopoietic stem cell transplantation; nonmyeloablative conditioning; prognosis.