CAJ | 학술논문

目的分析含去甲氧柔红霉素(IDA)预处理方案应用于异基因造血干细胞移植(HSCT)治疗高危难治性白血病的效果.方法 2012年6月至2014年8月共完成21例高危难治性白血病患者的异基因HSCT移植,其中单倍体移植18例,HLA配型相合同胞移植2例,脐带血移植1例.21例患者的原发病分别为急性淋巴细胞白血病(ALL)8例,急性髓系白血病(AML) 12例,慢性髓系白血病急变期(CML-BP)1例.预处理方案包括:IDA联合改良白消安+环磷酰胺方案(BuCy方案)2例,IDA联合全身照射(TBI)+环磷酰胺方案(TBI/Cy方案)6例,IDA联合TBI+氟达拉滨+阿糖胞苷+粒细胞集落刺激因子方案(TBI/FLAG方案)4例,IDA联合FLAG/减量BuCy方案9例.采用SPSS统计学软件进行数据分析.结果 21例受者中20例稳定植活.白细胞植活中位时间为17 d(11～28 d),血小板植活中位时间为22 d(8～70d).7例受者发生急性移植物抗宿主病(GVHD),通过Kaplan-Meier曲线分析急性GVHD的累积发生率为(33.3±5.6)％,其中Ⅱ～Ⅳ度急性GVHD的累积发生率为(23.8±4.8)％.在可评估的20例受者中,1 1例发生慢性GVHD(广泛型10例,局限型1例),慢性GVHD的累积发生率为(67.9±2.2)％,其中,慢性广泛型GVHD的累积发生率为(65.7±2.2)％.中位随访时间为14个月(3～26个月),4例复发,均为血液学复发,累积复发率为(23.5±1.9)％.21例患者中16例存活,2年总体存活率及无病存活率分别为(72.8±1.8)％及(56.1±2.1)％.结论含去甲氧柔红霉素的预处理方案安全有效,可作为高危难治白血病患者移植的优选预处理方案.
목적 분석함거갑양유홍매소(IDA)예처리방안응용우이기인조혈간세포이식(HSCT)치료고위난치성백혈병적효과.방법 2012년6월지2014년8월공완성21례고위난치성백혈병환자적이기인HSCT이식,기중단배체이식18례,HLA배형상합동포이식2례,제대혈이식1례.21례환자적원발병분별위급성림파세포백혈병(ALL)8례,급성수계백혈병(AML) 12례,만성수계백혈병급변기(CML-BP)1례.예처리방안포괄:IDA연합개량백소안+배린선알방안(BuCy방안)2례,IDA연합전신조사(TBI)+배린선알방안(TBI/Cy방안)6례,IDA연합TBI+불체랍빈+아당포감+립세포집락자격인자방안(TBI/FLAG방안)4례,IDA연합FLAG/감량BuCy방안9례.채용SPSS통계학연건진행수거분석.결과 21례수자중20례은정식활.백세포식활중위시간위17 d(11～28 d),혈소판식활중위시간위22 d(8～70d).7례수자발생급성이식물항숙주병(GVHD),통과Kaplan-Meier곡선분석급성GVHD적루적발생솔위(33.3±5.6)％,기중Ⅱ～Ⅳ도급성GVHD적루적발생솔위(23.8±4.8)％.재가평고적20례수자중,1 1례발생만성GVHD(엄범형10례,국한형1례),만성GVHD적루적발생솔위(67.9±2.2)％,기중,만성엄범형GVHD적루적발생솔위(65.7±2.2)％.중위수방시간위14개월(3～26개월),4례복발,균위혈액학복발,루적복발솔위(23.5±1.9)％.21례환자중16례존활,2년총체존활솔급무병존활솔분별위(72.8±1.8)％급(56.1±2.1)％.결론 함거갑양유홍매소적예처리방안안전유효,가작위고위난치백혈병환자이식적우선예처리방안.
Objective To evaluate the therapeutic effects of conditioning regimen containing idarabicin (IDA) for refractory/recurrent leukemia.Method From June 2012 to August 2014, 21 patients with refractory/recurrent leukemia were enrolled, including 8 cases of acute lymphoblastic leukemia (ALL), 12 cases of acute myeloid leukemia (AML) and 1 case of chronic myelogenous leukemia-blastic phase (CML-BP).Eighteen of them received HLA-haplo-identical stem cells transplantation (HSCT) from parent or sibling donors.Two patients underwent HLA identical allo-HSCT and one received cord blood transplantation.Conditioning regiments consisted of idarubicin/total body irradiation/ara with fludarabine and granulocyte colony-stimulating factor (IDA/TBI/FLAG), IDA/ busulfan and cytoxan (BuCy), IDA/TBI/Cy, and IDA/FLAG that followed by reduced-intensified BuCy.Result All 21 patients but 1 achieved stable engraftment.The median time of neutrophils≥0.5 × 109/L was 17 (11-28) days.And for platelet≥20 × 109/L, the median was 22 (8-70) days.Seven patients developed acute graft-versus-host disease (GVHD), and the accumulative incidence of acute GVHD (aGVHD) was (33.3 ± 5.6)％.Five patients developed Ⅱ-Ⅳ grade of aGVHD, and the accumulative incidence was (23.8 ± 4.8)％.Among 21 evaluable patients, 11 patients developed chronic GVHD (cGVHD) (10 patients extensive, and 1 patients limited), and the accumulative incidence of cGVHD was (67.9± 2.2)％, and for extensive type, the accumulative incidence was (65.7 ± 2.2)％.The median follow-up time post transplantation was 14 (3-26) months.Four patients relapsed and the accumulative incidence of relapse was (23.5 ± 1.9) ％.Sixteen patients survived and the overall survival (OS) and disease-free survival (DFS) were (72.8 ± 1.8) ％ and (56.1 ± 2.1)％, respectively.Conclusion Our clinical results suggested that the combination of salvaged HSCT and prophylactic immunotherapy is a promising modality for treatment of refractory/recurrent leukemia, even with high leukemia burden.