Infusion of HLA-mismatched peripheral blood stem cells improves the outcome of chemotherapy for acute myeloid leukemia in elderly patients
Infusion of HLA-mismatched peripheral blood stem cells improves the outcome of chemotherapy for acute myeloid leukemia in elderly patients
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输注HLA不匹配的外周血干细胞可改善老年急性髓系白血病患者的化疗效果
DOI：
10.1182/blood-2010-06-288506
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发表时间：
2011-01-20
期刊：
影响因子：
20.3
通讯作者：
Ai, Hui-Sheng
中科院分区：
文献类型：
--
作者：
Guo, Mei;Hu, Kai-Xun;Ai, Hui-Sheng
老年急性髓系白血病(AML)的治疗效果仍不令人满意。研究表明，输注粒细胞集落刺激因子动员的供者外周血干细胞(G-PBSCs)可增强移植物抗白血病效应，加速造血恢复。将58例60~88岁AML患者随机分为阿糖胞苷联合米托蒽醌诱导化疗(对照组，n=28)和阿糖胞苷联合人白细胞抗原不相合G-PBSC诱导化疗(G-PBSC组，n=30)。获得完全缓解的患者再接受中剂量阿糖胞苷或阿糖胞苷加G-PBSCs缓解后2个周期的治疗。G-PBSC组完全缓解率(80.0%)明显高于对照组(42.8%；P=0.006)。G-PBSC组化疗后中性粒细胞和血小板中位恢复时间分别为11天和14.5天，对照组分别为16天和20天。G-PBSC组的两年无病生存概率显著高于对照组(38.9%比10.0%；P=0.01)。所有患者均未观察到移植物抗宿主病。4例女性患者均成功检测到持续供体微嵌合体。这些结果表明，G-PBSC联合常规化疗可能为老年AML患者提供一种有前途的治疗方法。(血。2011；117(3)：936-941)
Treatment outcome of acute myeloid leukemia (AML) in elderly patients remains unsatisfactory. It has been shown that the infusion of granulocyte colony-stimulating factor-mobilized donor peripheral blood stem cells (G-PBSCs) can enhance graft-versus-leukemia effects and speed hematopoietic recovery. Fifty-eight AML patients aged 60-88 years were randomly assigned to receive induction chemotherapy with cytarabine and mitoxantrone (control group; n = 28) or it plus human leukocyte antigen-mismatched G-PBSCs (G-PBSC group; n = 30). Patients who achieved complete remission received another 2 cycles of postremission therapy with intermediate-dose cytarabine or it plus G-PBSCs. The complete remission rate was significantly higher in the G-PBSC group than in the control group (80.0% vs 42.8%; P = .006). The median recovery times of neutrophils and platelets were 11 days and 14.5 days, respectively, in the G-PBSC group and 16 days and 20 days, respectively, in the control group after chemotherapy. The 2-year probability of disease-free survival was significantly higher in the G-PBSC group than in the control group (38.9% vs 10.0%; P = .01). No graft-versus-host disease was observed in any patient. Persistent donor microchimerism was successfully detected in all of the 4 female patients. These results indicate that G-PBSCs in combination with conventional chemotherapy may provide a promising treatment method for AML in elderly patients. (Blood. 2011; 117(3): 936-941)