中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2010年
2期
77-81
,共5页
王健民%章卫平%宋献民%冯曹波%杨建民%陈莉%侯军%周虹%倪雄%高磊%邱慧颖%李红梅%丁晓勤
王健民%章衛平%宋獻民%馮曹波%楊建民%陳莉%侯軍%週虹%倪雄%高磊%邱慧穎%李紅梅%丁曉勤
왕건민%장위평%송헌민%풍조파%양건민%진리%후군%주홍%예웅%고뢰%구혜영%리홍매%정효근
造血干细胞移植%移植预处理%白血病%髓样%慢性
造血榦細胞移植%移植預處理%白血病%髓樣%慢性
조혈간세포이식%이식예처리%백혈병%수양%만성
Hematopoietic stem cell transplantation%Reduced-intensity conditioning%Leukemia,myeloid,chronic
目的 观察和比较血缘与非血缘关系异基因外周血干细胞移植(allo-PBSCT)采用氟达拉滨(Flud)联合白消安(BU)组成的FB减低剂量预处理方案治疗慢性粒细胞白血病(CML)的疗效和移植相关并发症.方法 采用FB(Flud 30 mg·m~(-2)·d~(-1)×5d;BU 4 mg·kg~(-1)·d~(-1)×3 d)方案alloPBSCT治疗CML共44例,接受血缘关系移植29例(血缘组),接受非血缘关系移植15例(非血缘组).急性移植物抗宿主病(aGVHD)预防:血缘组为霉酚酸酯(MMF)+环孢素(CsA)+甲氨蝶呤(MTX),非血缘组在上述基础上另加兔抗人胸腺细胞球蛋白(ATG,5 mg/kg×4 d).结果所有患者移植后均取得造血功能重建,血缘组与非血缘组中性粒细胞＞0.5×10~9/L的中位时间分别为13.7(9～18)d和13.6(12～17)d,血小板＞20×10~9/L的中位时间分别为15.3(9～20)d和14.7(10～26)d.但血缘组与非血缘组分别有2例与1例患者移植后5～8个月发生继发性植入排斥,其中血缘组1例再次行同一供体移植,重获造血功能重建.血缘组累计发生aGVHD共4例(13.8%),均为Ⅱ度;存活6个月以上28例患者中发生慢性GVHD(cGVHD)13例(46.4%),其中局限型和广泛型分别为10例和3例.非血缘组累计发生aGVHD共5例(33.3%),其中Ⅰ～Ⅱ度4例,Ⅲ度1例;存活6个月以上14例患者中发生cGVHD 8例(57.1%),其中局限型和广泛型分别为5例和3例.血缘组有2例患者移植后复发,给予冻存G-CSF动员的供者外周血干细胞输注(DSI)1～2次后再获得CR.本组中位随访时间34.7(2～73)个月,累计移植相关死亡10例(22.7%),主要死因是间质性肺炎、GVHD及继发排斥伴重症感染;34例患者存活,预期5年总生存率(0S)和无病生存率(DFS)分别为77.0%和73.9%;其中,血缘关系移植5年0s和DFS分别为79.0%和74.1%,非血缘关系移植5年OS和DFS均为73.3%.结论 以氟达拉滨联合白消安组成的减低剂量预处理方案allo-PBSCT治疗CML,无论是血缘移植还是非血缘移植均安全有效,重度GVHD发生率和术后复发率均不高,但少数患者需加强植入监测,并及时采用DSI或DLI等干预治疗.
目的 觀察和比較血緣與非血緣關繫異基因外週血榦細胞移植(allo-PBSCT)採用氟達拉濱(Flud)聯閤白消安(BU)組成的FB減低劑量預處理方案治療慢性粒細胞白血病(CML)的療效和移植相關併髮癥.方法 採用FB(Flud 30 mg·m~(-2)·d~(-1)×5d;BU 4 mg·kg~(-1)·d~(-1)×3 d)方案alloPBSCT治療CML共44例,接受血緣關繫移植29例(血緣組),接受非血緣關繫移植15例(非血緣組).急性移植物抗宿主病(aGVHD)預防:血緣組為黴酚痠酯(MMF)+環孢素(CsA)+甲氨蝶呤(MTX),非血緣組在上述基礎上另加兔抗人胸腺細胞毬蛋白(ATG,5 mg/kg×4 d).結果所有患者移植後均取得造血功能重建,血緣組與非血緣組中性粒細胞＞0.5×10~9/L的中位時間分彆為13.7(9～18)d和13.6(12～17)d,血小闆＞20×10~9/L的中位時間分彆為15.3(9～20)d和14.7(10～26)d.但血緣組與非血緣組分彆有2例與1例患者移植後5～8箇月髮生繼髮性植入排斥,其中血緣組1例再次行同一供體移植,重穫造血功能重建.血緣組纍計髮生aGVHD共4例(13.8%),均為Ⅱ度;存活6箇月以上28例患者中髮生慢性GVHD(cGVHD)13例(46.4%),其中跼限型和廣汎型分彆為10例和3例.非血緣組纍計髮生aGVHD共5例(33.3%),其中Ⅰ～Ⅱ度4例,Ⅲ度1例;存活6箇月以上14例患者中髮生cGVHD 8例(57.1%),其中跼限型和廣汎型分彆為5例和3例.血緣組有2例患者移植後複髮,給予凍存G-CSF動員的供者外週血榦細胞輸註(DSI)1～2次後再穫得CR.本組中位隨訪時間34.7(2～73)箇月,纍計移植相關死亡10例(22.7%),主要死因是間質性肺炎、GVHD及繼髮排斥伴重癥感染;34例患者存活,預期5年總生存率(0S)和無病生存率(DFS)分彆為77.0%和73.9%;其中,血緣關繫移植5年0s和DFS分彆為79.0%和74.1%,非血緣關繫移植5年OS和DFS均為73.3%.結論 以氟達拉濱聯閤白消安組成的減低劑量預處理方案allo-PBSCT治療CML,無論是血緣移植還是非血緣移植均安全有效,重度GVHD髮生率和術後複髮率均不高,但少數患者需加彊植入鑑測,併及時採用DSI或DLI等榦預治療.
목적 관찰화비교혈연여비혈연관계이기인외주혈간세포이식(allo-PBSCT)채용불체랍빈(Flud)연합백소안(BU)조성적FB감저제량예처리방안치료만성립세포백혈병(CML)적료효화이식상관병발증.방법 채용FB(Flud 30 mg·m~(-2)·d~(-1)×5d;BU 4 mg·kg~(-1)·d~(-1)×3 d)방안alloPBSCT치료CML공44례,접수혈연관계이식29례(혈연조),접수비혈연관계이식15례(비혈연조).급성이식물항숙주병(aGVHD)예방:혈연조위매분산지(MMF)+배포소(CsA)+갑안접령(MTX),비혈연조재상술기출상령가토항인흉선세포구단백(ATG,5 mg/kg×4 d).결과소유환자이식후균취득조혈공능중건,혈연조여비혈연조중성립세포＞0.5×10~9/L적중위시간분별위13.7(9～18)d화13.6(12～17)d,혈소판＞20×10~9/L적중위시간분별위15.3(9～20)d화14.7(10～26)d.단혈연조여비혈연조분별유2례여1례환자이식후5～8개월발생계발성식입배척,기중혈연조1례재차행동일공체이식,중획조혈공능중건.혈연조루계발생aGVHD공4례(13.8%),균위Ⅱ도;존활6개월이상28례환자중발생만성GVHD(cGVHD)13례(46.4%),기중국한형화엄범형분별위10례화3례.비혈연조루계발생aGVHD공5례(33.3%),기중Ⅰ～Ⅱ도4례,Ⅲ도1례;존활6개월이상14례환자중발생cGVHD 8례(57.1%),기중국한형화엄범형분별위5례화3례.혈연조유2례환자이식후복발,급여동존G-CSF동원적공자외주혈간세포수주(DSI)1～2차후재획득CR.본조중위수방시간34.7(2～73)개월,루계이식상관사망10례(22.7%),주요사인시간질성폐염、GVHD급계발배척반중증감염;34례환자존활,예기5년총생존솔(0S)화무병생존솔(DFS)분별위77.0%화73.9%;기중,혈연관계이식5년0s화DFS분별위79.0%화74.1%,비혈연관계이식5년OS화DFS균위73.3%.결론 이불체랍빈연합백소안조성적감저제량예처리방안allo-PBSCT치료CML,무론시혈연이식환시비혈연이식균안전유효,중도GVHD발생솔화술후복발솔균불고,단소수환자수가강식입감측,병급시채용DSI혹DLI등간예치료.
Objective To evaluate the overall efficacy and transplant-related mortality (TRM) of related and unrelated allogeneic peripheral blood hematopoietic stem cell transplantation (allo-PBSCT) in chronic myeloid leukemia (CML) patients conditioned with fludarabine-busulfan(FB) reduced intensity regimen.Methods Forty-four patients received FB(Flud 30 mg·m~(-2)·d~(-1)×5 d,BU 4 mg.kg~(-1)·d~(-1)×3 d)
conditioning followed by allo-PBSCT.Of them,29 patients were transplanted with related donor and 15 unrelated donor (URD).All patients received mycophenolate mofetil (MMF),CsA and MTX for acute GVHD (aGVHD) prophylaxis.5 mg/kg rabbit-antithymocyte globulin (ATG-Fresenius) was incorporated in 15 URD recipients.Results All patients were successfully engrafted.The median times to ANC above 0.5×10~9/L in related (RG) and unrelated groups (URG) were 13.7 (9-18) d and 13.6 (12-17) d,and PLT above 20×10~9/L were 15.3 (9-20) d and 14.7 (10-26) d,respectively.Two patients in RG.1 in URG developed graft rejection 5-8 months after transplantation.One of the two patients in RG received second transplantation and engrafted.The cumulative incidence of aGVHD and cGVHD were 13.8% (4/29)and 46.4% (13/28) in RG,and were 33.3% (5/15) and 57.1% (8/14) in URG respectively.Two patients in RG relapsed after transplantation,and obtained CR again after donor stem cell infusion(DSI).Median time of follow-up was 34.7 (2-73) months.Thirty-four patients were alive and 10 died.The main causes of death were IP,GVHD,graft rejection and infection.The 5-year overall survival (OS) probability was 77.0%,and the disease-free-survival (DFS) was 73.9%,of which,79.0% and 74.1% were in RG,and 73.3% and 73.3% in URG,respectively.Conclusions Fludarabine-busulfan based reduced intensity conditioning for allo-PBSCT with either related or unrelated donors is a safe,less toxic and curative approach to CML.
