白血病异基因造血干细胞移植术后中枢神经系统复发的临床研究被引量：2

Clinical study of central nervous system relapse of leukemia after allogeneic hematopoietic stem cell transplantation

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摘要目的探讨白血病异基因造血干细胞移植(allo-HSCT)术后中枢神经系统(CNS)的复发和预后情况。方法回顾性分析288例白血病患者[急性淋巴细胞白血病(ALL)98例、慢性粒细胞白血病(CML)99例、急性粒细胞白血病(AML)85例和急性混合细胞白血病6例]allo-HSCT术后CNS的复发率、危险因素和防治措施。结果 288例患者中,造血干细胞移植(HSCT)后出现CNS复发的8例(ALL4例,AML 3例,CML急淋变1例),累计发生率2.78%,中性复发时间160.5 d(95～622 d)。移植前伴有和不伴有中枢神经系统白血病(CNSL)病史者,移植后CNS复发率分别为13.04%和1.89%。移植前不伴CNSL的患者中,以ALL移植后CNS复发的风险最高(2.50%),其次为AML(2.47%),而全部66例CML-CP(慢性期)患者中未出现CNS复发。对于移植前不伴CNSL的患者,移植后预防性鞘注化疗与CNS的复发无关。8例CNS复发患者中,存活3例,2年总生存率为50%。结论急性白血病患者(特别是移植前伴CNSL者)allo-HSCT术后CNS的复发并非罕见,且预后欠佳。早期诊断和治疗有助于改善预后。 Objective To study central nervous system（CNS） relapse of leukemia after allogeneic hematopoietic stem cell transplantation（HSCT） in order to get the correlation factors and outcome.Methods We reviewed the data of 288 patients with leukemia（98ALL/85AML/6 mix-AL/99CML） who received allogeneic HSCT in our hospital and retrospectively analyzed the incidence,risk factors,treatment and outcome of patients with CNS relapse.Results Eight patients developed CNS relapse at 160.5（95～622） days after HSCT with a cumulative incidence of 2.78%.The cumulative incidences of CNS relapse in patients with and without a history of CNS involvement before HSCT were 13.04%and 1.89%,respectively.ALL were at higher risk for CNS relapse in patients without a history of CNS involvement before HSCT（ALL 2.50%,AML 2.47%,and CML-CP 0%）.In addition,it could not show a beneficial effect of prophylactic intrathecal chemotherapy on the incidence of CNS relapse in patients without a history of CNS involvement before HSCT.Three of the eight patients were alive,and,the 2-year overall survival（OS） after CNS relapse was 50%.Conclusion CNS relapse is not uncommon after HSCT in patients with acute leukemia,especially with a history of CNS involvement before HSCT,and they have high mortality and poor prognosis.Early diagnosis and appropriate management are crucial to the improvement of clinical outcomes in these patients.

作者李来玲王兴兵孙自敏刘会兰耿良权丁凯阳刘欣杨会志韩永胜汤宝林朱小玉薛磊姚雯朱薇波王祖贻

机构地区安徽医科大学附属省立医院血液科

出处《安徽医科大学学报》 CAS 北大核心 2013年第1期43-46,共4页 Acta Universitatis Medicinalis Anhui

基金国家自然科学基金(编号:31101006) 安徽省115产业创新团队项目(皖人才办[2009]2号) 安徽省高校省级科学研究项目(编号:KJ2012Z188)

关键词中枢神经系统复发白血病异基因造血干细胞移植 central nervous system relapse leukemia allogeneic HSCT

分类号 R552 [医药卫生—血液循环系统疾病]

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1Schlenk R F,Dohner K,Mack S,et al. Prospective evaluation ofallogeneic hematopoietic stem-cell transplantation from matched re-lated and matched unrelated donors in younger adults with high-risk acute myeloid leukemia : German-Austrian trial AMLHD98A[J]. J Clin Oncol,2010,28.30) :4642 -8.
2Thompson C B,Sanders J E,Flournoy N, et al. The risks of cen-tral nervous system relapse and leukoencephalopathy in patients re-ceiving marrow transplants for acute leukemia [ J ]. Blood,1986 ,67(1): 195 -9.
3Ganem G,Kuentz M, Bemaudin F, et al. Central nervous systemrelapses after bone marrow transplantation for acute lymphoblasticleukemia in remission [ J ]. Cancer, 1989 ,64 (9 ) : 1796 - 804.
4Singhal S,Powles R, Treleaven J, et al. Central nervous systemrelapse after bone marrow transplantation for acute leukemia in firstremission[ J]. Bone Marrow Transplant, 1996 ,17(4) :637 -41.
5Oshima K, Kanda Y, Yamashita T, et al. Central nervous systemrelapse of leukemia after allogeneic hematopoietic stem cell trans-plantation [J ]. Biol Blood Marrow Transplant, 2008 , 14 ( 10 ):1100-7.
6Ruutu T,Corradini P, Gratwohl A, et al. Use of intrathecalprophylaxis in allogeneic haematopoietic stem cell transplantationfor malignant blood diseases : a survey of the European Group forBlood and Marrow Transplantation ( EBMT) [ J ]. Bone MarrowTransplant,2005 ,35(2) : 121 -4.
7Ocheni S, Iwanski G B, Schaihausen P,et al. Characterisation ofextramedullary relapse in patients with chronic myeloid leukemia inadvanced disease after allogeneic stem cell transplantation [ J ].Leuk Lymphoma, 2009 ,50(4) :551 - 8.
8Au W Y, Lie A K,Liang R,et al. Isolated extramedullary relapseof acute lymphoblastic leukemia after allogeneic bone marrow trans-plantation[ J]. Bone Marrow Transplant, 1999,24( 10) :1137 -40.
9Ohashi H, Kato C,Fukami S,et al. Leukemic relapse in the cen-tral nervous system after allogeneic stem cell transplantation withcomplete remission in the bone marrow and donor type ehimerism :report of two cases[ J]. Am J Hematol,2005 ,79(2) : 142 -6.
10Lee K H, Lee J H,Choi S J, et al. Bone marrow vs extramedul-lary relapse of acute leukemia after allogeneic hematopoietic celltransplantation : risk factors and clinical course [ J ]. Bone MarrowTransplant,2003 ,32(8) :835 -42.