Allogeneic hematopoietic stem cell transplantation for chronic myelomonocytic leukemia

Yuanyuan Shi, Yi He, Gui-xin Zhang, W. Zhai, Qiao-ling Ma, A. Pang, Donglin Yang, Rong-li Zhang, Jialin Wei, E. Jiang, M. Han
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Abstract

Objective To explore the therapeutic efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in chronic myelomonocytic leukemia (CMML) patients. Methods The clinical data were retrospectively analyzed for 19 CMML patients undergoing allo-HSCT. Engraftment, graft versus host disease (GVHD), infection, relapse, splenomegaly and survival were observed. And the clinical outcomes of allo-HSCT for CMML were analyzed. Results Hematopoiesis reconstitution was not attained in 2 recipients due to early death post-transplantation. Neutrophil engraftment was obtained in 17 recipients with a median time of 14(11-18) days. Neutrophil engraftment and platelet engraftment were achieved in 15 recipients with a median time of platelet engraftment at 15 (12~70) days. Seven patients developed acute GVHD (grade 1, n=5; grade 2~4, n=3) while another 8 patients had chronic GVHD (extensive, n=5). Ten patients (52.6 %)had palpable splenomegaly (SPM) before allo-HSCT, 8 patients were diagnosed ultrasonically after transplantation, all 4 patients without a significant reduction of spleen died while all 4 patients with a significant reduction of spleen survived. After a median follow-up period of 31 (6-68) months, 3-year overall survival (OS), disease-free survival (DFS), cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) were (58.2±12.5)%, (36.3±14)%, (39.9±19)% and (37±12.6)% respectively. Conclusions As an effective therapy for CMML, allo-HSCT may improve the survival of CMML patients. Palpable SPM pre-transplantation and no significant reduction post-transplantation are probably poor prognostic factor. Key words: Allogeneic hematopoietic stem cell transplantation; Leukemia; Splenomegaly
异基因造血干细胞移植治疗慢性髓细胞白血病
目的探讨同种异体造血干细胞移植治疗慢性髓细胞白血病(CMML)的疗效。方法回顾性分析19例接受同种异体造血干细胞移植的CMML患者的临床资料。观察移植、移植物抗宿主病(GVHD)、感染、复发、脾肿大和存活情况。分析同种异体造血干细胞移植治疗CMML的临床结果。结果2例受者因移植后早期死亡未能实现造血功能重建。17例受者获得中性粒细胞移植,平均时间为14(11-18)天。15例患者获得了中性粒细胞植入和血小板植入,血小板植入的中位时间为15(12~70)天。7例患者发生急性GVHD(1级,n=5;2~4级,n=3),慢性GVHD 8例(广泛,n=5)。10例(52.6%)患者在同种异体造血干细胞移植前有可触及的脾肿大(SPM), 8例患者在移植后超声诊断为脾肿大,4例脾未明显缩小者全部死亡,4例脾明显缩小者全部存活。中位随访31(6-68)个月后,3年总生存期(OS)、无病生存期(DFS)、累计复发率(CIR)和非复发死亡率(NRM)分别为(58.2±12.5)%、(36.3±14)%、(39.9±19)%和(37±12.6)%。结论同种异体造血干细胞移植是治疗CMML的有效方法,可提高CMML患者的生存率。移植前可触及的SPM和移植后无明显减少可能是预后不良的因素。关键词:异基因造血干细胞移植;白血病;脾肿大
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