地西他滨桥接单倍体造血干细胞移植治疗难治性急性单核细胞白血病并文献复习

Decitabine in Haploidentical Hematopoietic Stem Cell Transplantation for Treatment Refractory Acute Monocytic Leukemia and Literature Review

目的 探讨地西他滨（DAC）用于难治急性单核细胞白血病患者进行异基因造血干细胞移植（allo-HSCT）之前桥接治疗的可行性及其疗效.方法 选择2011年11月解放军总医院第一附属医院收治的1例难治急性单核细胞白血病患者为研究对象.本例患者连续接受7个方案化疗,并给予DAC桥接治疗及白消安＋环磷酰胺（BUCY）改良方案预处理后,行单倍体造血干细胞移植（haplo-HSCT）,回顾性分析该例患者临床资料并结合近年相关文献进行分析.本研究遵循的程序符合解放军总医院第一附属医院人体试验委员会制定的伦理学标准,得到该委员会批准,并征得受试对象的知情同意.结果 该例患者经DAC桥接治疗后,预处理过程顺利,干细胞植入成功,仅出现Ⅰ度急性移植物抗宿主病（aGVHD）,局限性慢性GVHD（cGVHD）,移植后1个月、6个月、12个月及24个月时,患者均呈完全供者嵌合体型,且未检测到微小残留病（MRD）病灶.本例患者获得完全缓解（CR）,迄今已病情无复发存活25个月.结论 对于本例多耐药的难治性急性白血病患者,给予DAC桥接haplo-HSCT治疗,安全可行,并可有效减轻移植后复发风险,明显提高患者生存时间.

Objective To investigate the feasibility and efficacy of decitabine （DAC） bridge therapy followed by allogeneic hematopoietic stem cell transplantation （allo-HSCT） in patients with refractory acute monocytic leukemia （AML）.Methods In November 2011,a case of refractory acute AML who admitted by the First Affiliated Hospital of Chinese PLA General Hospital was included in this study.This patient recived 7 kinds of chemotherapy regimens,and then underwent with DAC bridge therapy and busulfan combined cyclophosphamide （BUCY） regimen before haploidentical HSCT （haplo-HSCT）.The clinical data of this patient were analyzed retrospectively,and its related literatures were reviewed.The clinical protocol and consent forms were approved by the institutional review board for human investigation at the First Affiliated Hospital of Chinese PLA General Hospital.Patient provided written informed consent for inclusion in the study.Results With DAC bridge therapy,this patient achieved successful engraftment and experienced only grade Ⅰ actue graft-versus-host disease （aGVHD） and limited chronic GVHD （cGVHD）.This patient achieved full donor chimerism （FDC） and didn＆#39;t monitor minimal residual disease （MRD） in 1,6,12 and 24 months after HSCT.Until now,he was in 25 months progression-free survival （PFS） and no relapse.Conclusions DAC bridge therapy followed by haplo-HSCT is safe and feasibility for the patient with multidrug resistance （MDR） and refractory AML,which could reduce the relapse efficiently and prolong life-span of the patients.