大剂量烷化剂为主的预处理方案在造血干细胞移植中的相关毒性与疗效

Curative effects and regimen-related toxicity of alkylate-based preparative regimens for hematopoietic stem cell transplantation

目的 观察烷化剂为主的化疗作预处理 ,并进行造血干细胞移植治疗 12例恶性血液病的相关毒性和疗效。方法 毒性分级用 Bearman等制订的标准 ,并统计分析完全缓解 ( CR)率、复发率和无病生存期。结果 1例无任何毒性发生。以烷化剂为主的大剂量化疗预处理方案的髓外毒性 ( RRT)主要表现在口腔粘膜和胃肠道。BU/CY方案发生了多脏器 级 RRT。移植后全部患者造血功能获得重建 ,无 1例发生移植相关死亡 ,9/12例移植后持续 CR,生存期最长达 4 6个月。结论 烷化剂为主的大剂量化疗预处理对急性白血病和淋巴瘤有良好疗效 ,且髓外 RRT轻。BY/CY方案剂量需调整或对方案进行改良。

Objective To evaluate the effects and regimen related toxicity(RRT) of alkylating agent based chemotherapy as conditioning regimen on hematopoietic stem cell transplantation(HSCT) in 12 patients with hematologic malignancies and solid tumours,.Methods RRT was graded according to Bearman's proposal. The period of hematopoietic reconstitution, the rate of complete remission and relpse and disease free survival were observed in transplant recipients. Results One patient did not show any toxicity.The individual organ toxicity related to high dose alkylate based chemotherapy was principally stomatitis and gastrointestional toxicity.A marrow recipient using BU/Cy protocol developed a grade Ⅲ RRT. The hematopoiesis was reconstituted in all patients and there were no patients died of transplantation associated complications. Nine of 12 cases who received transplantation remained to be continuous complete remission and the longest duration of disease free survival reached 46 months after transplantation.Conclusion High dose alkylate based chemotherapy as preparative regimen might be a safe, effective and economic conditioning protocol for HSCT in acute leukemias and malignant lymphoma. BU/CY conditioning regimen should be modified or the chemotherapeutic doses needed to be modulated if necessarily.