异基因造血干细胞移植治疗有侵袭性真菌感染史的急性白血病3例并文献复习

Allogeneic haematopoietic stem cells transplantation in acute leukemia with a history of invasive fungal infection——3 cases report and literature review

目的:探讨有侵袭性真菌感染史的急性白血病患者进行异基因造血干细胞移植(allo-HSCT)的可行性。方法:3例急性白血病患者移植前均有真菌感染病史,2例肺部真菌感染,1例肺部及肝脾真菌感染,经抗真菌治疗病情好转后行异基因HSCT。所选供者均为HLA-A、B、DR位点全相合的同胞兄弟姐妹,使用改良BU/CY预处理方案,用MTX加CsA预防急性移植物抗宿主病,移植0 d开始使用抗真菌药预防真菌感染。结果:随访1年半,3例患者无白血病复发,1例出现肺部真菌感染,抗真菌治疗后好转。余2例真菌感染病灶均稳定。结论:通过控制真菌感染的易感因素及再次预防,有真菌感染史的急性白血病进行HSCT是可行的。

Objective：To observe the reliability of haematopoietic stem cells transplantation（HSCT） in patients with acute leukemia and a history of invasive fungal infeetion（IFI）. Method：Three patients suffered fungal infection before they received allo-HSCT. Two of them suffered pulmonary fungal infection. One of them suffered pulmona ry, liver and spleen fungal infection. The donors were the sibling and were matched with the recipient in HLA-A, B, DR locus. After modified Bu/Cy conditioning regiment and MTX＋CsA were given for prophylaxis of acute graft versus host disease（aGVHD）. Anti-fungal drugs were given for prophylaxis at 0 day. Result： After 1.5 years observation, there is no recurrent of leukemia. One patient suffered pulmonary fungal infection after transplantation were cured by anti-fungal treatment. The other two fungal infection were stability or improved. Conclusion ： HSCT in the treatment of leukemia with a history of IFI is reliable through controlling some susceptible factors and secondary prophylaxis.