自体与同胞全相合造血干细胞移植治疗PH(+)急性淋巴细胞白血病的疗效比较

OBJECTIVE: To compare the efficacy of autologous HSCT（auto-HSCT）with matched sibling donor（MSD）HSCT in Ph(+) ALL and provide a basis for the choice of transplantation method. METHODS: We retrospectively investigated the outcomes of 78 adult patients with Ph(+) ALL who underwent auto-HSCT（n＝31）and MSD-HSCT（n＝47）in Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, from January 2008 to December 2017. The overall survival（OS）rate, leukemia-free survival（LFS）rate, cumulative incidence of relapse（CIR）rate, nonrelapse mortality（NRM）rate, and the impact of achievement of complete molecular response（CMR）within 3 months and sustaining CMR up to transplantation（s3CMR）on transplantation method were explored. RESULTS: The median time of neutrophil and platelet reconstitution in auto-HSCT and MSD-HSCT groups were 12（10–29）days vs 14（11–24）days（P＝0.006）and 17.5（10–62）days vs 7（10–33）days（P＝0.794）, respectively. In the MSD-HSCT group, the incidence of Ⅱ–Ⅳ and Ⅲ–Ⅳ acute graft-versus-host disease（GVHD）was 27.7%（13/47）and 8.5%（4/47）, respectively. The incidence of limited and extensive chronic GVHD was 17.0%（8/47）and 12.8%（6/47）, respectively. The estimated CIR, NRM, LFS, and OS at 3 years were not significantly different between auto-HSCT and MSD-HSCT groups（P>0.05）. For 44 patients who achieved s3CMR, 3-year OS［（84.0±8.6）% vs（78.0±8.7）%, P＝0.612］, LFS［（70.3±10.3）% vs（68.2±10.1）%, P＝0.970］, CIR［（24.9±10.0）% vs（14.4±8.0）%, P＝0.286］, and NRM［（4.7±4.7）% vs（17.4±8.1）%, P＝0.209］of the auto-HSCT and MSD-HSCT groups were not significantly different. However, for 34 patients who did not reach s3CMR, 3-year cumulative relapse rate of patients in the auto-HSCT group was significantly higher than MSD-HSCT group［（80.0±14.7）% vs（39.6±10.9）%, P＝0.057］. CONCLUSION: auto-HSCT with maintenance therapy after HSCT appears to be an attractive treatment option for patients with Ph(+) ALL especially for those with s3CMR maintained up to transplantation. For non-s3CMR patients, allogeneic transplantation may be more effective from lower relapse.