减低剂量预处理对异基因造血干细胞移植治疗恶性血液病疗效观察

Effect on Allogeneic Hematopoietic Stem Cell Transplantation With Dose-Redused Conditioning in Treatment of Hematological Malignancies

目的:探讨应用减低剂量的氟达拉宾、白消安和环磷酰胺(FBC)方案预处理对异基因造血干细胞移植(alloHSCT)治疗恶性血液病疗效的影响。方法:19例恶性血液病患者移植前进行减低剂量的FBC预处理。采用磷酸氟达拉宾(Flud)30mg/m2·d-1静脉滴注5d。白消安(Bu)0.6mg/kg、4次/d,共3d。环磷酰胺(CTX)30mg/kg·d-1静脉滴注,共2d,随后施行HLA配型的同胞或父亲供者的造血干细胞移植。术后采用环孢素及霉酚酸酯预防移植物抗宿主病(GVHD)。结果:全部患者的造血功能均获得快速重建。白细胞升至1.0×109/L以上,中位时间为(11.4±4.6)d。中性粒细胞升至0.5×109/L以上,中位时间为(11.9±6.7)d;血小板升至20×109/L以上,中位时间为(12.2±3.5)d。供者细胞完全植入15例,混合嵌合性植入4例,1例出现宿主排斥移植物(HVG)反应,进行供者淋巴细胞输注(DLI)2次后,达到完全供者嵌合。11例出现急性GVHD(57.89%),7例出现慢性GVHD(36.83%),2例HLA配型不完全相合者死于急性GVHD。结论:减毒的FBC预处理方案allo-HSCT治疗恶性血液病疗效肯定,并发症少,是治疗恶性血液病的有效方法。

Objective：To summarize and discuss the efficacy of allogeneic hematopoietic stem cell transplantation （Allo-HSCT） with dose-reduced FBC conditioning regimen composed of fludarabine, busulphan and cyclophosphamide in treatment of hematological malignancies. Methods： 19 patients were conditioned by fludarabine 30 mg/m^2 ·d^-1 for 5 d,busulphan 0. 6 rng/kg q6h for 3 d and cyclophosphamide 30 mg/（kg·d） for 2 d and received hematopoietic stem cells from chiefly sibling donors. Cyclosporin A and mycophenolate mofetil were used to prevent graft-versus-host disease（GVHD）. Results： All patients were engrafted with donor cells（ 15 with complete durable engraftment ,4 with mixed chimerism） and the time required to achieve recovery of hematopoisis： WBC〉 1×10^9/L was （11.4 ± 4. 6）d, neutrophil〉0. 5 ×10^9/L was （11.9 ± 6. 7） d and platelet〉20×10^9/L was （12.2 ± 3. 5） d. 11 cases （57. 89%） developed acute GVHD and 2 of them with HLA mismatched donors died, 7 cases（36. 83%） developed chronic GVHD. Conclusion.The procedure is safe, effective and with less complications and may represent a new approach in management of patients with hematological malignancies.