CAJ | 학술논문

目的探讨含氟达拉滨的预处理方案对单倍型造血干细胞移植(HSCT)治疗的可行性和安全性.方法对35例恶性血液病患者进行单倍型HSCT,其中标危4例,高危16例,复发未缓解15例,所有患者改良预处理用氟达拉滨取代静脉环磷酰胺,氟达拉滨用量为40 mg·m-2·d-1,连用5 d,供者接受rhG-CSF后采集造血干细胞,1例外周血HSCT,1例骨髓移植,33例骨髓加外周血造血干细胞联合移植,移植后观察预处理方案相关不良反应、植入、移植物抗宿主病(GVHD)发生和无病生存状况.结果所有患者均植入成功,34例患者第1次取得持久植入;1例患者排斥母亲植入物后再进行父亲供髓移植后取得持久植入.所有患者均能较好耐受该预处理方案,无一例因预处理相关不良反应而早期死亡,无肝静脉闭塞病发生.Ⅲ～Ⅳ度急性GVHD 4例,Ⅲ度以上急性GVHD累计发生率为12.1%,慢性GVHD累汁发生率为31.7%.随访时间为8～25个月,死亡6例,复发死亡3例,而非疾病复发死亡3例,其中急性GVHD死亡例,真菌感染死亡1例,其余29例患者仍无病存活,Kaplan-Meier分析无病生存率达79.7%.结论单倍型移植预处理用氟达拉滨取代静脉环磷酰胺安全可行,降低了方案相关不良反应,且未增加复发和感染率,有利于减少严重急性GVHD、提高移植成功率.
목적 탐토함불체랍빈적예처리방안대단배형조혈간세포이식(HSCT)치료적가행성화안전성.방법 대35례악성혈액병환자진행단배형HSCT,기중표위4례,고위16례,복발미완해15례,소유환자개량예처리용불체랍빈취대정맥배린선알,불체랍빈용량위40 mg·m-2·d-1,련용5 d,공자접수rhG-CSF후채집조혈간세포,1예외주혈HSCT,1례골수이식,33례골수가외주혈조혈간세포연합이식,이식후관찰예처리방안상관불량반응、식입、이식물항숙주병(GVHD)발생화무병생존상황.결과 소유환자균식입성공,34례환자제1차취득지구식입;1례환자배척모친식입물후재진행부친공수이식후취득지구식입.소유환자균능교호내수해예처리방안,무일례인예처리상관불량반응이조기사망,무간정맥폐새병발생.Ⅲ～Ⅳ도급성GVHD 4례,Ⅲ도이상급성GVHD루계발생솔위12.1%,만성GVHD루즙발생솔위31.7%.수방시간위8～25개월,사망6례,복발사망3례,이비질병복발사망3례,기중급성GVHD사망례,진균감염사망1례,기여29례환자잉무병존활,Kaplan-Meier분석무병생존솔체79.7%.결론 단배형이식예처리용불체랍빈취대정맥배린선알안전가행,강저료방안상관불량반응,차미증가복발화감염솔,유리우감소엄중급성GVHD、제고이식성공솔.
Objective To explore the feasibility and safety of conditioning regimen containing fludarabine (Flud) for haploidentieal hematopoietic stem cell transplantation (HSCT).Methods Preparative regimen containing Flud 40 mg·m-2·d-1 on day-7 to-3 in place of eyelophosphamide(CTX) for haploidentical HSCT was given to 35 patients with hematologic malignancies (4 standard risk,16 high risk,15 relapse with no remission).All donors received rhG-CSF followed by HSC harvest.One patient received peripheral blood HSCT(PBSCT),one bone marrow transplantation(BMT),and the others BM combination with PBSCT.The regimen-associated side effect,engraftment,incidence of graft-versus-host disease (GVHD) and disease-free survival(DFS) probabilities were observed.Results All patients achieved sustained,full donortype engraftment.Thirty-four patients obtained primary durable engraftment,and i who rejected graft from his mother obtained successful durable engraftment after the second graft from his father.The cumulative incidence of grade Ⅲ-Ⅳ acute GVHD and chronic GVHD was 12.1% and 31.7%,respectively.With a follow-up duration of 8-25 months,6 patients were dead,in which 3 died of relapse,2 of acute GVHD,1 of fungal infection,none died of regimen-associated side effect.The other 29 patients remained alive and DFS probability was 79.7%.Conclusion Flud based conditioning regimens for haploidentical HSCT is safe and feasible,which reduces regimen-associated side effect,with no increasing the rate of relapse and infection,and decreases the incidence of aGVHD.