CAJ | 학술논문

背景:选择高效低毒的预处理方案是提高造血干细胞移植成功率的关键.氟达拉滨和抗胸腺细胞球蛋白,均属于强效免疫抑制剂,常用于非清髓性造血干细胞移植预处理中.目的:对采用氟达拉滨或抗胸腺细胞球蛋白为基础的非清髓性异基因造血干细胞移植预处理方案患者,在预处理中及移植后早期毒性进行比较.方法:32例血液系统恶性肿瘤患者中,按照非清髓性预处理方案中的免疫抑制剂分成两组即氟达拉滨组和抗胸腺细胞球蛋白组,预处理方案均为氟达拉滨或抗胸腺细胞球蛋白联合减低化疗强度的白消安/环磷酰胺,或者马法兰.抗胸腺细胞球蛋白组在形成混合性嵌合体后进行供者淋巴细胞输注.对两组患者预处理中出现的器官毒性进行统计学分析,毒性分级参照 Bearman 等制订的预处理相关毒性(RRT)分级标准.结果与结论:两组无因预处理相关毒性而死亡.氟达拉滨组转氨酶发生率、腹泻发生率与和抗胸腺细胞球蛋白组比较差异均无显著性意义(P >0.05);氟达拉滨组肝脏毒性发生率、黏膜炎发生率均显著低于抗胸腺细胞球蛋白组(P <0.05);血液学毒性方面,氟达拉滨组白细胞达最低值、血小板≥50×109 L-1的时间、输注红细胞量、输注血小板的量均低于抗胸腺细胞球蛋白组(P <0.05).
배경:선택고효저독적예처리방안시제고조혈간세포이식성공솔적관건.불체랍빈화항흉선세포구단백,균속우강효면역억제제,상용우비청수성조혈간세포이식예처리중.목적:대채용불체랍빈혹항흉선세포구단백위기출적비청수성이기인조혈간세포이식예처리방안환자,재예처리중급이식후조기독성진행비교.방법:32례혈액계통악성종류환자중,안조비청수성예처리방안중적면역억제제분성량조즉불체랍빈조화항흉선세포구단백조,예처리방안균위불체랍빈혹항흉선세포구단백연합감저화료강도적백소안/배린선알,혹자마법란.항흉선세포구단백조재형성혼합성감합체후진행공자림파세포수주.대량조환자예처리중출현적기관독성진행통계학분석,독성분급삼조 Bearman 등제정적예처리상관독성(RRT)분급표준.결과여결론:량조무인예처리상관독성이사망.불체랍빈조전안매발생솔、복사발생솔여화항흉선세포구단백조비교차이균무현저성의의(P >0.05);불체랍빈조간장독성발생솔、점막염발생솔균현저저우항흉선세포구단백조(P <0.05);혈액학독성방면,불체랍빈조백세포체최저치、혈소판≥50×109 L-1적시간、수주홍세포량、수주혈소판적량균저우항흉선세포구단백조(P <0.05).
@@@@BACKGROUND: The highly-effective conditioning regimens of proper dose and low-toxicity are the key to the successful hematopoietic stem cel transplantation. Fludarabine and antithymocyteglobulin are intensive immunosuppressants, and are usual y used in conditioning regimen of non-myeloablative hematopoietic stem cel transplantation. OBJECTIVE: To compare the toxicity of fluadarabine versus antithymocyteglobulin in the conditioning regimen of non-myeloablative al ogeneic hematopoietic stem cel transplantation. METHODS: Thirty-two patients with malignant hematologic diseases were divided into fludarabine group and antithymocyteglobulin group according to the difference of immunosuppressants in conditioning regimen. Conditioning regimen consisted of fluadarabine or antithymocyteglobulin combined with the reduced-dose busulfan and cyclophosphamide or L-Sarcolysinum. The donor lymphocyte infusion was performed after the formation of mixed chimerism in antithymocyteglobulin group. The toxicity in the two groups was statistical y analyzed, and the regimen-related toxicity was scored using the criteria of Bearman. RESULTS AND CONCLUSION: No one died of regimen-related toxicity in two groups. There were no significant differences in the incidence of transaminase and diarrhea between fluadarabine and antithymocyteglobulin groups (P > 0.05); while the incidence of liver toxicity and mucositis in fluadarabine group was lower than that in the antithymocyteglobulin group (P < 0.05). About hemotologic toxicity, the time for white blood cel count reaching the lowest value and platelets ≥50×109/L, the volume of infused red cells and the volume of infused platelets in the fluadarabine group were lower than those in the antithymocyteglobulin group (P < 0.05).