摘要
目的 分析减低剂量预处理单倍型外周血造血干细胞移植(RIC-haplo-PBSCT)治疗50岁以上恶性血液肿瘤患者的疗效.方法 18例50岁以上恶性血液肿瘤患者纳入研究,男8例,女10例,中位年龄52(50~66)岁;急性髓系白血病(AML)8例,慢性髓性白血病(CML)2例,骨髓增生异常综合征(MDS)5例,急性淋巴细胞白血病(ALL)2例,急性NK细胞白血病(ANKL)1例;采用FAB+ATG(氟达拉滨+阿糖胞苷+白消安+兔抗人胸腺细胞免疫球蛋白)减低剂量预处理方案,输注供者高剂量非去T细胞外周血造血干细胞(PBSC),应用强化移植物抗宿主病(GVHD)预防方案及感染防控措施.结果 16例患者在移植后15 d获得完全供者嵌合,其中1例在移植后1个月发生移植排斥,其余2例在移植后15 d为混合嵌合并于移植后1个月发生移植排斥.急性GVHD发生率为61.1%(95%CI 49.6%~72.6%),Ⅱ~Ⅳ度急性GVHD发生率为35.4%(95%CI 21.1%~49.7%),Ⅲ/Ⅳ度急性GVHD发生率为13.8%(95%CI 4.7%~22.9%).2年慢性GVHD累积发生率为38.2%(95%CI 25.5%~50.9%),未发生广泛型慢性GVHD.中位随访14.5(3~44)个月,2年总生存率、无病生存率分别为72.6%(95%CI 60.1%~85.1%)、63.7%(95%CI 49.2%~78.2%),2年累积复发率为31.2%(95%CI 16.5%~45.9%),2年非复发死亡率为12.5%(95%CI 4.2%~20.8%).结论 RIC-haplo-PBSCT治疗50岁以上恶性血液肿瘤患者可获得较好的疗效.
Objective To analyze the efficacy of HLA-haploidentical peripheral hematopoietic stem cell transplantation(haplo-PBSCT)following reduced intensity conditioning(RIC)regimen to treat the patients with hematological malignancies who were older than 50 years old.Methods Eighteen patients with hematological malignancies over 50 years were enrolled,including 8 male and 10 female patients.The median age of all patients was 52(range:50–66)years.Of them,8 patients had acute myeloid leukemia(AML),2 chronic myelocytic leukemia(CML),5 myelodysplastic syndrome(MDS),2 acute lymphoblastic leukemia(ALL),and 1 aggressive natural killer cell leukemia(ANKL).All patients received fludarabine,cytarabine and melphalan with rabbit anti-human thymocyte globulin(FAB+rATG regimen)and transplanted with high dose non-T cell-depleted peripheral hematopoietic stem cells from donors.Enhanced graft versus host disease(GVHD)prophylaxis and infection prevention were administered.Results Fifteen days after transplantation,16 patients achieved complete donor chimerism.One of them rejected the donor graft completely at thirty days after transplantation,and the other 2 patients had mixed chimerism 15 days after transplantation and converted to complete recipient chimerism at 30 days after transplantation.The cumulative incidence of acute GVHD(aGVHD)was 61.1%(95%CI49.6%-72.6%).The incidence of gradeⅡ-ⅣaGVHD was 35.4%(95%CI 21.1%-49.7%),whereas grade III-IV was 13.8%(95%CI 4.7%-22.9%).The 2-year cumulative incidence of chronic GVHD(cGVHD)rate was estimated at 38.2%(95%CI 25.5%-50.9%).Patients were followed-up for a median of 14.5 months(range,3-44 months).The Kaplan Meier estimates of 2-year overall survival(OS)and disease-free survival(DFS)was 72.6%(95%CI 60.1%-85.1%)and 63.7%(95%CI 49.2%-78.2%),respectively.The 2-year cumulative incidence of relapse and non-relapse-mortality(NRM)was 31.2%(95%CI 16.5%-45.9%)and 12.5%(95%CI 4.2%-20.8%),respectively.Conclusion RIC-haplo-PBSCT protocol can achieve better results in patients with hematologic malignancies over 50 years old.
作者
刘颖
袁海龙
段显琳
徐建丽
曲建华
陈刚
石佳
韩春霞
丁凌陆
江明
Liu Ying;Yuan Hailong;Duan Xianlin;Xu Jianli;Qu Jianhua;Chen Gang;Shi Jia;Han Chunxia;Ding Linglu;Jiang Ming(Hematologic Disease Center,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Xinjiang Uygur Autonomous Region Research Institute of Hematology,Urumqi 830061,China)
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2019年第8期667-672,共6页
Chinese Journal of Hematology
基金
国家自然科学基金(81660032).
关键词
移植预处理
单倍型外周血造血干细胞移植
血液肿瘤
Transplantation conditioning
Haploidentical peripheral hematopoietic stem cell transplantation
Hematologic malignancy
作者简介
通信作者:江明,Email:jiangmingyy@126.com
