中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2011年
20期
1379-1383
,共5页
张钰%陈银葵%刘启发%范志平%江千里%赵婕%韦祁%李小芳%余国攀%孙竞%柴燕燕
張鈺%陳銀葵%劉啟髮%範誌平%江韆裏%趙婕%韋祁%李小芳%餘國攀%孫競%柴燕燕
장옥%진은규%류계발%범지평%강천리%조첩%위기%리소방%여국반%손경%시연연
白血病%移植预处理%造血干细胞移植
白血病%移植預處理%造血榦細胞移植
백혈병%이식예처리%조혈간세포이식
Leukemias%Transplantation conditioning%Hematopoietic stem cell transplantation
目的 分析两种不同强度预处理方案对系列不明急性白血病(ALAL)异基因造血干细胞移植(allo-HSCT)的疗效.方法 回顾性分析南方医科大学附属南方医院血液内科2002年3月至2010年8月38例ALAL患者临床资料.标准清髓性预处理方案为全身放疗+环磷酰胺或白消安+环磷酰胺;超强预处理方案为氟达拉滨+阿糖胞苷+全身放疗+环磷酰胺.移植物抗宿主病(GVHD)预防在人白细胞抗原(HLA)全相合相关移植患者用环孢素A(CsA)+甲氨蝶呤(MTX),HLA不相合相关移植及无关移植患者采用CsA+MTX+抗胸腺细胞球蛋白和(或)霉酚酸酯.COX模型分析影响长生存的因素.结果 19例患者接受标准预处理方案;19例接受超强预处理方案.移植后38例患者均获造血重建,5年累计总体总生存(OS)和无病生存(DFS)率分别为35.5%和25.7%;标准预处理组和超强预处理组5年0s率分别为20.2%与48.1%(P=0.233)、DFS为6.5%与43.1%(P:0.031).38例患者移植后5年白血病累计复发率为58.9%,标准预处理组和超强预处理组分别为87.6%和30.4%(P=0.003).COX单因素分析显示:超强预处理及慢性GVHD为DFS的保护因素(P=0.001、0.031).结论 在allo-HSCT中应用超强预处理能改善ALAL患者的生存及减少复发,移植物抗白血病效应对ALAL患者具有一定疗效.
目的 分析兩種不同彊度預處理方案對繫列不明急性白血病(ALAL)異基因造血榦細胞移植(allo-HSCT)的療效.方法 迴顧性分析南方醫科大學附屬南方醫院血液內科2002年3月至2010年8月38例ALAL患者臨床資料.標準清髓性預處理方案為全身放療+環燐酰胺或白消安+環燐酰胺;超彊預處理方案為氟達拉濱+阿糖胞苷+全身放療+環燐酰胺.移植物抗宿主病(GVHD)預防在人白細胞抗原(HLA)全相閤相關移植患者用環孢素A(CsA)+甲氨蝶呤(MTX),HLA不相閤相關移植及無關移植患者採用CsA+MTX+抗胸腺細胞毬蛋白和(或)黴酚痠酯.COX模型分析影響長生存的因素.結果 19例患者接受標準預處理方案;19例接受超彊預處理方案.移植後38例患者均穫造血重建,5年纍計總體總生存(OS)和無病生存(DFS)率分彆為35.5%和25.7%;標準預處理組和超彊預處理組5年0s率分彆為20.2%與48.1%(P=0.233)、DFS為6.5%與43.1%(P:0.031).38例患者移植後5年白血病纍計複髮率為58.9%,標準預處理組和超彊預處理組分彆為87.6%和30.4%(P=0.003).COX單因素分析顯示:超彊預處理及慢性GVHD為DFS的保護因素(P=0.001、0.031).結論 在allo-HSCT中應用超彊預處理能改善ALAL患者的生存及減少複髮,移植物抗白血病效應對ALAL患者具有一定療效.
목적 분석량충불동강도예처리방안대계렬불명급성백혈병(ALAL)이기인조혈간세포이식(allo-HSCT)적료효.방법 회고성분석남방의과대학부속남방의원혈액내과2002년3월지2010년8월38례ALAL환자림상자료.표준청수성예처리방안위전신방료+배린선알혹백소안+배린선알;초강예처리방안위불체랍빈+아당포감+전신방료+배린선알.이식물항숙주병(GVHD)예방재인백세포항원(HLA)전상합상관이식환자용배포소A(CsA)+갑안접령(MTX),HLA불상합상관이식급무관이식환자채용CsA+MTX+항흉선세포구단백화(혹)매분산지.COX모형분석영향장생존적인소.결과 19례환자접수표준예처리방안;19례접수초강예처리방안.이식후38례환자균획조혈중건,5년루계총체총생존(OS)화무병생존(DFS)솔분별위35.5%화25.7%;표준예처리조화초강예처리조5년0s솔분별위20.2%여48.1%(P=0.233)、DFS위6.5%여43.1%(P:0.031).38례환자이식후5년백혈병루계복발솔위58.9%,표준예처리조화초강예처리조분별위87.6%화30.4%(P=0.003).COX단인소분석현시:초강예처리급만성GVHD위DFS적보호인소(P=0.001、0.031).결론 재allo-HSCT중응용초강예처리능개선ALAL환자적생존급감소복발,이식물항백혈병효응대ALAL환자구유일정료효.
objective To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT)in the conditionings of different intensities for acute leukemias of ambiguous lineage(ALJAL). Methods A total of 38 ALAL patients were treated with two conditionings of different intensities in our hospital from March 2002 to August 2010. The standard conditioning included TBI+Cy or Bu+Cy,intensified conditioning included Fludarabine+Ara-C+TBI+Cy. Cyelosporine A(CsA)and methotrexate (MTX) were administered in patients with human leukocyte antigen-matched sibling donor. And CsA, MTXplus antihuman thymocyte globulin and/or mycophenolate were used in all patients with HLA-A-mismatched related donor and unrelated donors transplants for graft-versus-host disease(GVHD)prophylaxis. COX regression was used to evaluate the prognostic factors of ALAL Results Among 38 ALAL patients,19received the standard conditioning while another 19 the intensified conditioning. All patients achieved hematopoietic reconstitution. The 5-year overall survival(OS)and the disease-free survival(DFS)were 35. 5%and25. 7%respectivelv. The 5-year OS rates were 20. 2%and48. 1%(P=0. 233)and DFS 6. 5%and 43. 1%(P=0. 031)in the standard and intensified conditioning groups respectively. The 5-year cumulative relapsing incidence was 58. 9%in all patients and 87. 6% vs 30. 4% in the standard and intensifted conditioning groups respectively(P=0. 003). Through a COX regression model for univariate analysis, the intensified conditioning and chronic GVHD were protective factors for DFS (P = 0. 001,0. 031 ). Conclusions The intensified conditioning in ALAL patients undergoing allo-HSCT may improve the long-term patient survival and decrease the relapse of leukemia. The graft versus leukemic effect has some efficacy in ALAL patients undergoing allo-HSCT.
