非血缘脐血移植治疗急性髓系白血病58例疗效分析

OBJECTIVE: To evaluate the therapeutic efficacy and related risk factors of acute myelogenous leukemia (AML) patients treated with unrelated cord blood transplantation (UCBT). METHODS: A retrospective analysis was performed on the clinical data of 58 AML patients that consisted of 1 case of M(0), 1 case M(1), 35 cases M(2), 3 cases M(4), 14 cases M(5), 3 cases M(6), and 1 case acute mixed leukemia, respectively. Of them, 1 case AML secondary to myelodysplastic syndrome, and 36 in first complete remission (CR(1)), 14 in second complele remission (CR(2)), 8 in non-remission (NR), 43 cases were refractory or high-risk patients (70.1%). The median age was 14.5 years with the median weight of 45 kg, 49 patients received sUCBT and 9 dUCBT. All the patients conditioned with intensified myeloablative regimen and received a combination of Cyclosporine A (CsA) and mycophenolate mofetil (MMF) to prevent graft-versus-host disease (GVHD). RESULTS: 56 out of 58 patients achieved engraftment with implantation rate 96.6%. The median time of ANC≥0.5×10(9)/L was 17 (12–37) days, and that of PLT≥20×10(9)/L 33 (17–140) days respectively. 24 cases developed acute GVHD (aGVHD), the incidence rate of grade Ⅱ to Ⅳ aGVHD was 30.4%. The chronic GVHD (cGVHD) was occured in 7 patients of the 49 evaluable patients, all were limited. The estimated 3-year overall survival (OS) and disease-free survival (DFS) were (60.3±6.4)% and (60.1±6.5)% respectively. And the cumulative incidences of 3-year non-relapse mortality (NRM) and relapse were 33.3% and 9.1% respectively. The 3-year OS rates of AML patients were (66.0±6.7)% for CR and (25.0±15.3)% for NR, differences were statistical significance. CONCLUSION: For AML patients, UCBT was conducive to improve outcome with lower incidences of cGVHD and relapse, the patients after transplantation could obtain high quality of life.