探究三维调强放射治疗(IMRT)对急性髓系白血病(AML)异基因造血干细胞移植(allo-HSCT)后髓外复发的疗效观察。

回顾性分析2018年11月至2022年8月贵阳市第一人民医院收治的AML行allo-HSCT后髓外复发患者临床资料，根据治疗方式不同分为化疗组(41例)和IMRT组(36例)。比较两组患者一般资料、近期疗效、生物标志物和预后情况。采用Kaplan-Meier法进行生存分析，并采用log-rank检验进行比较。计量资料组间比较采用成组t检验或重复测量资料的方差分析进行比较，计数资料组间比较采用χ²检验或Fisher确切概率法。P<0.05为差异具有统计学意义。

IMRT组并发症发生比例为5.56%(2/36)，化疗组为24.39%(10/41)，差异有统计学意义(χ²＝5.169，P<0.05)。IMRT组完全缓解＋部分缓解的比例为91.67%(33/36)，高于化疗组[70.73%(29/41)]，差异有统计学意义(χ²＝5.356，P<0.05)。IMRT组患者治疗前及治疗后1、3和5个月血清VEGF水平分别为(754.14±66.27)、(586.03±50.24)、(364.08±48.62)和(253.26±45.20)pg/mL，CD56^＋NK细胞比例分别为(6.14±1.27)%、(10.03±1.65)%、(11.62±1.34)%和(11.36±1.63)%；化疗组VEGF水平分别为(748.26±64.25)、(526.15±50.76)、(407.43±47.32)和(303.85±45.86)pg/mL，CD56^＋NK细胞比例分别为(6.32±1.30)%、(10.53±1.47)%、(11.86±1.66)%和(11.09±1.78)%。两组血清VEGF水平差异有统计学意义(F_交互＝19.661，P<0.05)；两组CD56^＋NK细胞比例差异无统计学意义(F_交互＝0.084，P>0.05)，但两组组内时间维度差异存在统计学意义(F_时间＝203.602，P<0.05)。随访截至2023年12月，IMRT组无进展生存率为91.67%，化疗组为63.41%，差异有统计学意义(χ²＝8.542，P<0.05)。

IMRT在AML患者行allo-HSCT后髓外复发的治疗中具有一定疗效，可改善临床疗效，减轻患者局部症状，与IMRT抑制肿瘤血管生成机制有关。

To investigate the efficacy of three-dimensional intensity modulated radiation therapy (IMRT) on extramedullary relapse after allogeneic haematopoietic stem cell transplantation (allo-HSCT) for acute myeloid leukaemia (AML).

The clinical data of 77 AML patients treated with allo-HSCT in the First People′s Hospital of Guiyang from November 2018 to August 2022 were retrospectively analysed and divided into the chemotherapy group (41 cases) and the IMRT group (36 cases) according to the treatment modality. The general data, recent efficacy, biomarkers and prognosis of patients between the two groups were compared. Survival analysis was performed using the Kaplan-Meier method, and log-rank test was used for comparison. Measurement data between the groups were compared using the paired t-test or the repeated measures analysis of variance for comparison of data, and count data were compared between the groups using the χ² test or Fisher′s exact probability method. P<0.05 was considered statistically significant.

The incidence of complications in the IMRT group was 5.56% (2/36), while in the chemotherapy group it was 24.39% (10/41), with a statistically significant difference (χ²=5.169, P<0.05). The proportion of complete and partial remission in the IMRT group was 91.67% (33/36), which was higher than that in the chemotherapy group [70.73% (29/41)], with a statistically significant difference (χ²=5.356, P<0.05). Before and after 1, 3, and 5 months of treatment, the serum VEGF levels in the IMRT group were (754.14±66.27), (586.03±50.24), (364.08±48.62) and (253.26±45.20) pg/mL, respectively; the proportion of CD56⁺ NK cells was (6.14±1.27)%, (10.03±1.65)%, (11.62±1.34)% and (11.36±1.63)%, respectively. The VEGF levels in the chemotherapy group were (748.26±64.25), (526.15±50.76), (407.43±47.32) and (303.85±45.86), respectively. The proportion of CD56⁺ NK cells was (6.32±1.30), (10.53±1.47), (11.86±1.66) and (11.09±1.78). The difference of serum VEGF levels between the two groups were statistically significant (F_time-group=19.661, P<0.05). No significant difference of the ratio of CD56⁺ NK cells was seen between the two groups (F_time-group=0.084, P>0.05), but significant difference of the ratio of CD56⁺ NK cells in different time points was seen within each group (F_time=203.602, P<0.05). The patients were followed up until December 2023, the ratio of progression-free survival of the chemotherapy group and the IMRT group were 63.41% and 91.67%, respectively, there was significant difference (χ²=8.542, P<0.05).

IMRT has a certain therapeutic effect in the treatment of extramedullary recurrence in AML patients after allo-HSCT, which can improve clinical efficacy, alleviate local symptoms, and is related to the mechanism of tumor angiogenesis inhibition.