摘要
目的分析采用全身照射(TBI)为主的不含抗胸腺细胞球蛋白(ATG)的清髓性预处理方案进行非血缘脐血移植(UCBT)治疗成人恶性血液病的安全性和疗效。方法2006年9月至2011年5月,单中心采用不含ATG由TBI、阿糖胞苷(Ara-c)、环磷酰胺(CY)组成的清髓性预处理方案进行UCBT治疗40例成人恶性血液病患者。患者平均年龄(23±6)岁,平均体重(58±9)kg。40例患者中高危难治患者35例(87.5%),进展期进行移植患者15例(37.5%)。单份脐血移植23例,双份脐血移植17例。75.0%(30/40)患者存在HLA1-2个位点不合。移植物抗宿主病(GVHD)预防采用环孢素A联合霉酚酸酯方案。结果受者输入脐血总有核细胞平均数为(4.1±1.1)×10^7/kg,CD34^+细胞平均数为(2.4±1.0)×10^5/kg。40例患者全部获得植入,植入率100%。中性粒细胞绝对值≥0.5×10^9/L的平均时间为(20±5)d,血小板≥20×10^9/L的平均时间为(384±12)d。40例中23例(57.5%)发生急性GVHD,其中Ⅲ-Ⅳ度4例(10.0%)。可评估的35例患者中8例(22.9%)发生慢性GVHD,均为局限型。12.5%(5/40)患者复发。存活患者中位随访时间19.8(4.6-55.0)个月。100d和1年移植相关病死率分别为15.0%、35.0%。主要死亡原因为严重肺部感染和重度急性GVHD。2年无病生存率和总生存率均为58.8%。疾病进展期与缓解期进行移植的患者2年累计生存率分别为48.6%和63.8%,差异无统计学意义(X^2=0.304,P=0.582)。结论采用TBI/Ara-c/CY预处理方案行成人UCBT耐受性好,全部患者均获得稳定植入,降低早期移植相关死亡。该方案用于高危、难治和进展期患者移植后复发率较低,慢性GVHD发生率低并均为局限型,获得较理想的生存率。
Objective To retrospectively analyze the curative efficacy of umbilical cord blood transplantation (UCBT) with improved myeloablative conditioning regimen (total body irradiation (TBI)/ cytosine arabinoside (Ara-e) / eyclophosphamide ( CY ) without antithymocyte globulin (ATG) ) in adult patients with hematological malignancies. Methods Forty consecutive adult patients with hematological malignancies received improved myeloablative unrelated CBT at a single center from September 2006 to May 2011. Their average age was (23± 6) years and the average weight (58 ± 9) kg. Thirty-five(87.5% ) patients were high-risk and 15 (37. 5% )at the advanced disease status at pre-transplantation. They received 1 ( n = 23) or 2 ( n = 17 ) cord blood units. Seventy-five percent of them were transplanted with 1/2- human leukocyte antigen mismatched uniL The conditioning regimen consisted of 12 Gy TBI, granuloeyte colony- stimulating factor (G-CSF) plus Ara-c and CY without ATG. All patients received a combination ofcyclosporine (CsA) and mycophenolate mofetil (MMF) for the prophylaxis of graft-versus-host disease (GVHD). Results For the entire group of patients, the average cell doses infused were (4. 1 ±1.1 ) ×10^7 total nucleated cells/kg and (2.4 ±1.0) × 105 CD34^± cells/kg. All patients acquired engraftment with an implantation rate of 100%. The average time of absolute neutrophil count ( ANC ) ≥ 0. 5 ×10^9/L was (20 ±5 ) days and the average time of platelet ≥20× 10^9/L was (38 ± 12 )days. Acute GVHD occurred in 23 patients(57.5% )and 4 (10. 0% ) were of grade Ⅲ -Ⅳ. Chronic GVHD occurred in 22. 9% (8/35) evaluable patients. Relapse occurred in 12. 5% (5/40) patients. During a median follow-up period of 19.8 (range 4. 6 -55.0) months,the transplantation-related mortality was 15.0% (6/40) within 100 days and 35.0% (14/40) within 1 year. The main causes of mortality were pneumonia and severe acute GVHD. Two-year overall survival (OS) or disease-free survival was 58. 8% and 58. 8% , respectively. Two-year OS for patients with advanced or complete remission disease was 48. 6% and 63.8%, respectively. Conclusions The TBI/Ara-c/CY myeloablative conditioning regimen is well-tolerated and capable of establishing sustained donor cell engraftment and decreasing the risks of transplant-related death in adults with hematologic malignancies. For the high-risk and advanced patients, it may reduce the occurrences of relapse and chronic GVHD.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第24期1660-1664,共5页
National Medical Journal of China
基金
安徽省“十二五”科技攻关(11010402164)
安徽省卫生厅医学科研重点项目(2010A005)
关键词
移植预处理
脐血干细胞移植
白血病
Transplantation conditioning
Cord blood stem cell transplantation
Leukemia