摘要
目的分析复发难治性急性髓系白血病(AML)挽救性异基因造血干细胞移植(allo—HSCT)的疗效。方法2006年9月至2010年4月共完成45例复发难治性AML挽救性allo—HSCT,预处理前骨髓中幼稚细胞中位数为0.360(0.200~0.920)。供者来源:同胞HLA配型6/6相合移植6例,非血缘关系移植9例,单倍体移植30例。预处理方案:改良BuCy(白消安+环磷酰胺)方案20例,大剂量阿糖胞苷(HDAra—C)+Bu/氟达拉滨(Flu)16例,FLAG/RICBuCy方案6例,全身照射(TBI)/Cy2例,TBI/FIu方案1例,根据患者病情可加入G—CSF、甲氨蝶呤、米托葸醌、替尼泊苷、阿克拉霉素、赛替哌等药物。结果43例患者稳定植活,1例于植活前死于多器官衰竭。1例植入失败复发,白细胞植活中位时间为14(10~21)d,血小板植活中位时间为15(9~79)d。20例患者发生急性移植物抗宿主病(GVHD),累计发生率为53.3%,其中Ⅱ~Ⅳ度累计发生率为34%。26例患者发生慢性GVHD,慢性GVHD的累计发生率为59.1%,其中广泛型GVHD的累计发生率为38.3%。发生CMV血症28例,细菌感染33例,真菌感染16例。11例患者复发,其中9例为血液学复发,1例为免疫学复发,1例为中枢神经系统复发,累计复发率为29.2%。中位随访时间为30(0.5~57)个月,45例患者中29例存活,3年总存活率及无病存活率分别为62.6%及60.2%。结论个体化预处理方案联合预防性的免疫治疗进行allo.HSCT是治疗复发难治AML有效可靠的手段。
Objective To evaluate the efficacy of salvaged allogeneic hematopoietic stem cell trans- plantation (allo-HSCT) for refractory/recurrent acute myeloid leukemia (AML). Methods A total of 45 pa- tients with refractory/recurrent AML were enrolled from September 2006 to April 2010. The median blasts in bone marrow (BM) were 36% (20% to 92% ) before conditioning. The donors were identical siblings (6) or unrelated ones (9) or haploidentical family members (30). Conditioning regiments were individualized ac- cording to patients'status, the regimen with high-dose cytarabine plus BuCy/CY was mostly used (20). The patients with impaired organ function received above regimen except using fludarabine instead of cyclophos- phamide (16). FLAG followed by reduced-intensified BuCy was employed for the recipients with more than 40% blasts in BM (6) to reduce leukemia burden. TBI/CY or TBI/Fludarabine was used for the recipients with extramedullary infiltration of leukemia or muhidmg resistant leukemia. G-CSF, MTX, NVT, Vm26, Acla or Thaltipa was added into conditioning regiments according to leukemia character. Results All but 2 patients attained durable engraftment. The incidence of grade U to IV aGVHD and cGVHD were 34% , 59.1% , respectively. With median follow-up 30 (0.5 -57) months, the relapse rate was 29.2%. Twenty- nine of 45 (60.2%) patients remained in complete remission since salvaged HSCT. Three-years disease-free survival and overall survival were 60.2% and 62.6%, respectively. Conclusion Our results indicated that the combination of salvaged HSCT with prophylactic immunotherapy might be a promising modality for treatment of refractory/recurrent AML, even with high leukemia burden.
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2012年第6期467-470,共4页
Chinese Journal of Hematology
关键词
白血病
非淋巴细胞
急性
复发
造血干细胞移植
Leukemia,nonlymphocytic, acute
Recurrence
Hematopoietic stem cell transplatation