白血病·淋巴瘤
白血病·淋巴瘤
백혈병·림파류
JOURNAL OF LEUKEMIA & LYMPHOMA
2014年
2期
79-83
,共5页
胡凯%王继军%田磊%万伟%赵伟%李其辉%克晓燕
鬍凱%王繼軍%田磊%萬偉%趙偉%李其輝%剋曉燕
호개%왕계군%전뢰%만위%조위%리기휘%극효연
白血病,急性%氟达拉滨%移植预处理%造血干细胞移植,异基因
白血病,急性%氟達拉濱%移植預處理%造血榦細胞移植,異基因
백혈병,급성%불체랍빈%이식예처리%조혈간세포이식,이기인
Leukemia,acute%Fludarabine%Transplantation conditioning%Hematopoietic stem cell transplantation,allogeneic
目的 探讨氟达拉滨替代改良BuCy方案中环磷酰胺的预处理方案在异基因造血干细胞移植中的安全性及有效性.方法 对45例急性白血病患者进行异基因造血干细胞移植,其中23例采用改良BuCy预处理化疗,22例采用BuFlu方案(氟达拉滨每天40 mg/m2,用5d,来替代改良BuCy方案中的环磷酰胺)进行预处理化疗.移植均采用外周血造血干细胞移植.移植后观察比较两组预处理方案相关不良反应、植入、移植物抗宿主病(GVHD)、感染发生和长期随访下的无病生存情况.结果 除改良BuCy组1例患者死于预处理后脑出血,其余患者均获得成功植入.两组患者预处理不良反应发生率差异无统计学意义(P＞0.05)；BuFlu组患者病毒感染较改良BuCy组高(P=0.009),而Ⅲ～Ⅳ度急性GVHD发生率较低[26.1％(6/23)比4.5％(1/22),P=0.046].中位随访41个月,改良BuCy组非复发死亡4例(17.4％),BuFlu组非复发死亡2例(9.1％)(P=0.665).两组复发率分别为30.3％(7/23)和40.9％(9/22)(P=0.474)；5年总生存率分别为(55.1±l 1.9)％和(61.4±10.8)％(P=0.659),无事件生存率分别为(44.5±12.1)％和(22.1±12.3)％(P=0.747).结论 氟达拉滨替代改良BuCy方案中环磷酰胺的预处理化疗耐受性较好,严重GVHD发生率低,总生存率无明显差异.应用时应注意移植中感染及复发的风险.
目的 探討氟達拉濱替代改良BuCy方案中環燐酰胺的預處理方案在異基因造血榦細胞移植中的安全性及有效性.方法 對45例急性白血病患者進行異基因造血榦細胞移植,其中23例採用改良BuCy預處理化療,22例採用BuFlu方案(氟達拉濱每天40 mg/m2,用5d,來替代改良BuCy方案中的環燐酰胺)進行預處理化療.移植均採用外週血造血榦細胞移植.移植後觀察比較兩組預處理方案相關不良反應、植入、移植物抗宿主病(GVHD)、感染髮生和長期隨訪下的無病生存情況.結果 除改良BuCy組1例患者死于預處理後腦齣血,其餘患者均穫得成功植入.兩組患者預處理不良反應髮生率差異無統計學意義(P＞0.05)；BuFlu組患者病毒感染較改良BuCy組高(P=0.009),而Ⅲ～Ⅳ度急性GVHD髮生率較低[26.1％(6/23)比4.5％(1/22),P=0.046].中位隨訪41箇月,改良BuCy組非複髮死亡4例(17.4％),BuFlu組非複髮死亡2例(9.1％)(P=0.665).兩組複髮率分彆為30.3％(7/23)和40.9％(9/22)(P=0.474)；5年總生存率分彆為(55.1±l 1.9)％和(61.4±10.8)％(P=0.659),無事件生存率分彆為(44.5±12.1)％和(22.1±12.3)％(P=0.747).結論 氟達拉濱替代改良BuCy方案中環燐酰胺的預處理化療耐受性較好,嚴重GVHD髮生率低,總生存率無明顯差異.應用時應註意移植中感染及複髮的風險.
목적 탐토불체랍빈체대개량BuCy방안중배린선알적예처리방안재이기인조혈간세포이식중적안전성급유효성.방법 대45례급성백혈병환자진행이기인조혈간세포이식,기중23례채용개량BuCy예처이화료,22례채용BuFlu방안(불체랍빈매천40 mg/m2,용5d,래체대개량BuCy방안중적배린선알)진행예처이화료.이식균채용외주혈조혈간세포이식.이식후관찰비교량조예처리방안상관불량반응、식입、이식물항숙주병(GVHD)、감염발생화장기수방하적무병생존정황.결과 제개량BuCy조1례환자사우예처리후뇌출혈,기여환자균획득성공식입.량조환자예처리불량반응발생솔차이무통계학의의(P＞0.05)；BuFlu조환자병독감염교개량BuCy조고(P=0.009),이Ⅲ～Ⅳ도급성GVHD발생솔교저[26.1％(6/23)비4.5％(1/22),P=0.046].중위수방41개월,개량BuCy조비복발사망4례(17.4％),BuFlu조비복발사망2례(9.1％)(P=0.665).량조복발솔분별위30.3％(7/23)화40.9％(9/22)(P=0.474)；5년총생존솔분별위(55.1±l 1.9)％화(61.4±10.8)％(P=0.659),무사건생존솔분별위(44.5±12.1)％화(22.1±12.3)％(P=0.747).결론 불체랍빈체대개량BuCy방안중배린선알적예처이화료내수성교호,엄중GVHD발생솔저,총생존솔무명현차이.응용시응주의이식중감염급복발적풍험.
Objective To evaluate the fludarabine instead of cyclophosphamide in modified busulfancyclophosphamide (mBuCy) regimen as a new myeloablative conditioning regimen for the treatment of acute leukemia patients receiving allogeneic hematopoietic stem cell transplantation (HSCT).Methods The clinic data of 45 acute leukemia patients undergoing allogeneic HSCT were analyzed.Among them,23 patients received mBuCy as conditioning regimen and 22 patients received BuFlu regimen (fludarabine 40 mg·m-2·d-1 for 5 days,instead of cyclophosphamide in mBuCy).Hematopietic engraftment,regimen-related toxicity (RRT),graft-versus-host disease (GVHD),infection condition,non relapse mortality,and overall survival were compared between the two groups.Results All patients achieved hematopoietic reconstitution and complete donor chimerism except for one patient of mBuCy group died of cerebral hemorrhage during conditioning.The incidence of RRT was no significant differences (P ＞ 0.05).In BuFlu group,the incidence of virus infection was higher (P =0.009),and the incidence of Ⅲll-Ⅳ aGVHD were 26.l ％ (6/23) and 4.5 ％ (1/22) (P =0.046) in mBuCy and in BuFlu group respectively.With a median follow up of 41 months,the incidence of non relapse mortality in mBuCy group was 17.4 ％ (4/23) and in BuFlu group was 9.1％ (2/22) (P =0.665).In mBuCy group and in BuFlu group,the relapse rates were 30.3 ％ (7/23) and 40.9 ％ (9/22) (P =0.474),the 5-year overall survival rates were (55.1±11.9) ％ and (61.4±10.8) ％ (P =0.659),and disease-free survival rates were (44.5±12.1) ％ and (22.1±12.3) ％ (P =0.747),respectively.Conclusions Fludarabine instead of cyclophosphamide in mBuCy regimen as a new myeloablative conditioning regimen has well tolerance,lower incidence of sever GVHD,satisfied overall survival,but the risk of infection and replase should be considered.
