Objective: To better understand predictive factors and role of autologous hematopoietic stem cell transplantation (auto-HSCT)in the post-remission therapy for adult Ph-negative B-cell acute lymphoblastic leukemia (B-ALL)patients.
Methods: Outcomes of 86 adult patients with B-ALL who received auto-HSCT in our center from January 1996 to February 2014 were retrospectively analyzed.
Results: Overall survival (OS)and disease free survival (DFS)at 5 years for the cohort were (63.8 ± 5.6)% and (60.9 ± 5.6)%, respectively. The cumulative non-relapse mortality (NRM)and relapse at 5 years were (4.70 ± 0.05)% and (34.40 ± 0.31)%. For DFS, age ≥ 35 years, high lactate dehydrogenase at diagnosis, high initial WBC count, blast cell proportion ≥ 5% on 15th day of the first induction therapy, complete remession (CR)1 to HSCT interval >6 months and CD34⁺ cells in graft ≥ 3.8 × 10⁶/kg were the poor prognostic factors. CR1 to HSCT interval >6 months was the independently undesirable factors in COX regression model. For 34 patients who had results of minimal residual disease (MRD), positive pretransplantation MRD (MRD≥0.01%), positive post-induction MRD or MRD positive again during the chemotherapy indicated poor prognosis, and the last one was the independent adverse prognostic factor.
Conclusion: Auto-HSCT combined with post-transplantation maintenance chemotherapy could be an optional approach for adult B-ALL patients. MRD plays a significant role in the treatment choice for adult Ph-negative B-ALL patients.
目的: 探讨自体造血干细胞移植（auto-HSCT）在成人Ph染色体阴性急性B淋巴细胞白血病（B-ALL）中的地位及其预后因素。
方法: 回顾性分析1996年1月至2014年2月86例首次行auto-HSCT患者的疗效。
结果: 5年总生存（OS）和无病生存（DFS）率分别为（63.8±5.6）％和（60.9±5.6）%，5年累积无复发死亡（NRM）率和复发率分别为（4.70±0.05）％和（34.40±0.31）%。年龄≥35岁、诊断时乳酸脱氢酶水平高、高白细胞起病、首次诱导治疗第15天骨髓原始细胞比例≥5%、第1次完全缓解（CR1）至移植时间间隔>6个月及回输物中CD34+细胞数≥3.8×106/kg均为不良预后因素。且CR1至移植时间间隔>6个月是影响预后的独立不良因素。34例患者具有微小残留病（MRD）检测结果，显示移植前MRD阳性（MRD≥0.01 %）、首次诱导化疗后MRD未转阴或巩固化疗过程中MRD转阳均提示不良预后，且巩固化疗中MRD转阳是影响DFS的独立不良因素。
结论: auto-HSCT联合维持化疗是成人B-ALL治疗的可选方案。由于移植前及化疗过程中MRD阴性结果提示更好的结局，故MRD可能在指导成人B-ALL移植治疗中具有重要意义。