Clinical analysis of sub-standard dose of donor stem cell infusion mobilized by granulocyte colony-stimulating factor in treatment of relapsed acute leukemia after allogenic hematopoietic stem cell transplantation

国际输血及血液学杂志 Pub Date : 2019-11-20 DOI:10.3760/CMA.J.ISSN.1673-419X.2019.06.003

Xiaoning Wang, Ying Zhang, Juan Ren, Huachao Zhu, Jieying Xi, Mei Zhang

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Abstract

Objective To investigate the clinical effect and prognosis of sub-standard dose of donor stem cell infusion(DSI) mobilized by granulocyte colony-stimu1ating factor(G-CSF) in patients with relapsed acute leukemia (AL) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods From January 2010 to April 2017, a total of 17 patients with relapsed AL after allo-HSCT in Department of Hematology, the First Affiliated Hospital of Xi′an Jiaotong University were included in the study. They were divided into DSI combined chemotherapy group (n=7) and chemotherapy alone group (n=10) according to different treatment after relapse. The basic clinical data of patients with relapsed AL after allo-HSCT were collected by retrospective analysis. The infusion dose of DSI, treatment results, adverse reactions and survival outcomes were observed in both groups. Kaplan-Meier method was used to draw the overall survival (OS) and survival after first relapse (SAR) curves of two groups. The OS and SAR rate were compared by Log-rank test between two groups. This study protocol was approved by the ethics committee of the First Affiliated Hospital of Xi′an Jiaotong University (Approoal No. XJTU1AF2010LSL-020). Informed consents were obtained from all patients before treatment. Results ① The median age of patients in DSI combined chemotherapy group was 28 years (11-49 years), 3 cases were positive in fusion gene, and 6 cases were achieved complete remission(CR)1 before transplantation, none of them had graft versus host disease(GVHD). The median age of patients in chemotherapy group was 22 years (15-37 years). The fusion gene was positive in 4 cases, and 2 cases had GVHD. ② In DSI combined chemotherapy group, 5 patients received single DSI treatment after conventional chemotherapy, and 2 patients received DSI treatment in every two weeks. Three patients (3 / 7) achieved CR. There were 4 patients with grade Ⅰ ~Ⅱ aGVHD of skin and liver, 3 patients with grade Ⅳ myelosuppression and pneumonia. Up to the end of follow-up, 1 patient survived and 6 died in DSI combined chemotherapy group. ③In the chemotherapy group, 3 patients (3 / 10) achieved CR after treatment. Up to the end of follow-up, 4 patients survived and 6 patients died. ④ The 1-year and 3-years OS rates of patients in DSI combined chemotherapy group were 57.1% and 19.0%, respectively, and those of patients in chemotherapy group were 66.7% and 17.8%, respectively. There were no significant differences between two groups (χ2 = 2.122, 0.136; P=0.58, 0.68). There was no significant difference in 1-year SAR rate between two groups (41.3% vs 29.8%; χ2=3.165, P=0.43). Conclusions The combination of G-CSF mobilized sub standard dose DSI with chemotherapy may improve the CR rate of patients with relapsed AL after allo-HSCT. Reducing dose of DSI may reduce the incidence of severe GVHD without affecting the therapeutic efficacy and graft versns leukemia(GVL) effect. Key words: Leukemia; Hematopoietic stem cell transplantation; Recurrence; Hematopoietic stem cell mobilization; Donor stem cell infusion

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粒细胞集落刺激因子动员供体干细胞输注亚标准剂量治疗同种异体造血干细胞移植后复发急性白血病的临床分析

目的探讨粒细胞集落刺激因子（G-CSF）动员亚标准剂量供体干细胞输注（DSI）治疗异基因造血干细胞移植（allo-HSCT）后复发性急性白血病（AL）的临床疗效和预后。方法自2010年1月至2017年4月，Xi交通大学第一附属医院血液科共17例异基因造血干细胞移植术后复发性AL患者纳入研究。根据复发后治疗的不同，分为DSI联合化疗组（n=7）和单纯化疗组（n=10）。通过回顾性分析收集allo-HSCT后复发AL患者的基本临床资料。观察两组DSI的输注剂量、治疗结果、不良反应和生存结果。采用Kaplan-Meier法绘制两组患者的总生存率（OS）和首次复发后生存率（SAR）曲线。通过对数秩检验比较两组患者OS和SAR的发生率。本研究方案经Xi交通大学第一附属医院伦理委员会批准（批准号：XJTU1AF2010LSL-020）。治疗前获得所有患者的知情同意。结果①DSI联合化疗组患者中位年龄28岁（11～49岁），3例融合基因阳性，6例移植前完全缓解（CR）1，无移植物抗宿主病（GVHD）。化疗组患者的中位年龄为22岁（15-37岁）。融合基因阳性4例，GVHD 2例DSI联合化疗组，5例患者在常规化疗后接受单一DSI治疗，2例患者每两周接受DSI治疗。3例（3/7）患者获得CR，其中4例为皮肤和肝脏aGVHDⅠ～Ⅱ级，3例为骨髓抑制和肺炎Ⅳ级。DSI联合化疗组截至随访结束，存活1例，死亡6例。③化疗组3例（3/10）患者治疗后CR。截至随访结束，存活4例，死亡6例。④DSI联合化疗组患者1年和3年OS发生率分别为57.1%和19.0%，化疗组患者分别为66.7%和17.8%。两组间比较无显著性差异（χ2=2.122,0.136；P=0.58,0.68），1年SAR率比较无显著差异（41.3%vs29.8%；χ2=3.165，P=0.43）。减少DSI的剂量可以在不影响治疗效果和移植物抗白血病（GVL）效果的情况下降低严重GVHD的发生率。关键词：白血病；造血干细胞移植；复发；造血干细胞动员；供体干细胞输注

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来源期刊

国际输血及血液学杂志

自引率

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10610

期刊介绍： The International Journal of Transfusion and Hematology was founded in September 1978. It is a comprehensive academic journal in the field of transfusion and hematology, supervised by the National Health Commission and co-sponsored by the Chinese Medical Association, West China Second Hospital of Sichuan University, and the Institute of Transfusion Medicine of the Chinese Academy of Medical Sciences. The journal is a comprehensive academic journal that combines the basic and clinical aspects of transfusion and hematology and is publicly distributed at home and abroad. The International Journal of Transfusion and Hematology mainly reports on the basic and clinical scientific research results and progress in the field of transfusion and hematology, new experiences, new methods, and new technologies in clinical diagnosis and treatment, introduces domestic and foreign research trends, conducts academic exchanges, and promotes the development of basic and clinical research in the field of transfusion and hematology.