标准分次放疗预处理的造血干细胞移植治疗恶性血液疾病

Hematopoietic Stem Cell Transplantation with Fractionated Total Body Irradiation Based Preparation Regimen in Patients with Malignant Hematologic Diseases

目的研究标准分次全身放疗（fTBI）预处理方案对自体、异体造血干细胞移植治疗恶性血液疾病疗效的影响。方法造血干细胞移植治疗28例恶性血液疾病患者，其中自体造血干细胞移植6例，异体造血干细胞移植22例，预处理方案为环磷酰胺（CY）＋标准分次全身放疗（fTBI）±依托泊苷（VP-16），其中TBI总量12Gy共6次，肺部8．5Gy。结果28例患者随访1～73月（中位随访时间17月），2年复发率（RR）为（30．1±10．5）％，2年总生存率（OS）为（57．1±10．4）％，1年移植相关死亡率（TRM）（12．5±6．8）％，2年TRM（18．3±8．5）％。按疾病阶段分组，标准危险组患者1年RR为（11．2±7．5）％；预期2年和5年RR均为（23．9±10．5）％；1年TRM为（10．6±7．1）％；预期2年和5年TRM为（16．6±8．8）％；1年OS（79．4±9．2）％，预期2年和5年OS均为（63．5±11．0）％；而高危组患者均为疾病晚期和（或）复发难治患者，其中位复发时间为5月，中位生存期仅5月，1年TRM为（16．7±15．2）％。结论对于标准危险的恶性血液疾病患者，CY＋fTBI±VP-16是有效的移植预处理方案。

Objective To evaluate the efficacy of hematopoietic stem cell transplantation with fractionated total body irradiation（fFBI） based preparation regimen in patients with malignant hematologic diseases. Methods A total of 28 consecutive patients with malignant hematologic diseases received hematopoietic stem cell transplatation （HSCT） , with autologous HSCT in 6 and allogeneic HSCT in 22. All patients received CY ± fFBI ± VP-16 as preconditioning with fTBI （total dose at 12 Gy, 2 Gy twice a day for 3 days, and 8.5 Gy for the pulmonary part）. Results With a median follow up of 17 months （1 -73 months）, the estimated 2-year relapse rate （RR） was （30.1 ± 10.5） %, while the estimated 2-year overall survival （OS） was （ 57. 1 ± 10.4 ） %. The actual one-year transplantation-related mortality （TRM） was （ 12.5± 6.8） % and the estimated 2-year TRM was （ 18.3± 8.5 ） %. According to the disease status, 22 patients with standard-risk disease had actual 1-year RR at （ 11.2 ± 7.5） % and esimated 2-year and 5-year RR at （23.9 ± 10.5） %. The actual 1-year TRM was （ 10.6 ± 7. 1 ） % and estimated 2-year and 5-year TRM was （16.6 ±8.8）%. The actual 1-year OS was （79.4 ±9.2）% and estimated 2-year and 5-year OS was （63.5 ± 11. 0）%. On the contrary, the result was much inferior in another 6 patients with high-risk disease status. The median time for relapse and survival time were both 5 months post-HSCT, and the 1-year TRM at （ 16.7 ± 15.2） %. Conclusion HSCT with CY ± fTBI ± VP-16 preconditioning would be an effective regimen for standard-risk patients with hematological malignancies.