异基因造血干细胞移植治疗50岁以上恶性血液病患者35例

Ailogeneic hematopoietic cell transplantation for malignant hematological diseases in patients older than 50 years of age

目的总结异基因造血干细胞移植治疗50岁以上恶性血液病患者的经验。方法2002年5月至2010年1月接受异基因造血干细胞移植的患者35例，患者年龄均超过50岁，其中18例接受减低剂量的预处理（非清髓组），17例接受清髓性预处理（清髓组）。统计受者干细胞植入情况，并发症发生情况以及存活情况。结果35例中，32例的粒系造血获得重建，粒系植入的中位时间为12d，血小板植入的中位时间为17d。急性移植物抗宿主病（GVHD）的发生率为48．6％，慢性GVHD的发生率为37．9％。受者5年预期存活率为48．5％，5年累积死亡率为51．5％，移植相关死亡率为22．9％，原发病复发率为11．4％。非清髓组慢性GVHD发生率高于清髓组，差异有统计学意义。其他指标的蒡异均无统计学意义。结论50岁以下恶性血液病患者可以进行异基因造血干细胞移植。

Objective To investigate the efficiency and safety of allogeneic hematopoietic cell transplantation for malignant hematological diseases in patients older than 50 yeas of age. Methods From May 2002 to January 2010, 35 patients （〉50 years） with malignant hematological diseases received allogeneic hematopoietic cell transplantation. In 35 patients, 18 patients were conditioned with non-myeloablative regimen and 17 patients with myeloablative regimen. The outcome, engraftment and prognosis of allogeneic hematopoietic cell transplantation were analyzed. Results The hematopoetic reconstitution was achieved in 32 of 35 patients. The median time of granulocyte count exceeding 0. 5 × 10^9/L was 12 days and the that of platetet count exceeding 20× 10^9/L was 17 days. The cumulative incidence of aGVHD was 48. 6 %, and 37. 9 % patients developed cGVHD. The estimate probability of cumulative survival at 5 years was 48. 5 %, The estimate probability of cumulative mortality rate was 51.5 %, and the estimated transplant-related mortality was 22. 9 %. The relapse rate was 11.4 G. There was significant difference except for the incidence of cGVHD. Conclusion Allogeneic hematopoietic cell transplantation may be appropriate for older patients with malignant hematological diseases.