异基因造血干细胞移植治疗高龄恶性血液病的疗效分析

Clinical analysis of allogeneic hematopoietic stem cell transplantation in olderly patients with malignant leukemia

目的探讨异基因造血干细胞移植治疗年龄较大的白血病患者安全性和疗效。方法采用HSCT治疗10例45—63岁恶性血液病患者，HLA6／6位点相合8例，5／6位点相合2例。以清髓性方案预处理4例，减低强度方案预处理6例。HLA不全相合患者加用ATG。采用环孢素联合霉酚酸酯预防移植物抗宿主病（GVHD）。结果本组10例受者均获造血重建。中性粒细胞绝对计数≥0．5×10^9／L，血小板≥20×10^9／L的中位时间分别为移植后12（9～16）天和15（12～21）天。3例发生了急性GVHD（30％），Ⅱ度以上2例。可评估的9例患者中2例出现了慢性GVHD（22％）。复发2例，死亡3例。可评估的2年无病生存率为70％。结论造血干细胞移植对于高龄白血病患者是一种有效、安全的根治疗法。

Objective To study the efficiency and safety of allogeneic stem cell transplantation （allo - HSCT） in treating older leukemia patients. Methods 10 patients undergone related allo-HSCT for malignant hematological diseases, 45-63 years old in all, 8 cases were matched for HLA antigens,2 cases were one loci mismatched. 4 cases conditioned with myeloablative regimen, others with reduced intensity regimen. All the patients received cyclosporine A and mycophenolate mofetil to prevent GVHD, HLA mis- matched cases plus ATG. Result The hematopoetic reconstitution was accelerated, The median number of days of granuloc）,te count exceeding 0.5 ×10^9/L and platelet count exceeding 20×10^9/L was 12 d（ range 9-16 d）and 15 d（ range 12-21 d）, respectively. The cumulative incidence of aGVHD was 30%, only two cases greater than grade Ⅱ . 2 of 9 evaluatable patients developed cGVHD, extensive cGVHD was 22%. 2 cases relapsed,3 cases died. The estimate probability of disease free survival at 2 years was 70%. Conclusion Allogeneic stem cell transplantation is safe and effective for older leukemia patients.