清肿瘤化疗方案联合低强度改良预处理方案用于异基因造血干细胞移植治疗30例恶性血液病的安全性和疗效初探

Safety and Effectiveness of Tumor-ablative Chemotherapy Combined with Low Intensity Modified Conditioning Regimen for 30 Patients with Hematologic Malignancies Receiving Allogeneic Hematopoietic Stem Cell Transplantation

本研究旨在探讨清肿瘤化疗方案联合低强度预处理方案用于异基因造血干细胞移植治疗恶性血液病的安全性及有效性。回顾性分析2012年1月1日-2013年1月1日接受本预处理方案的30例恶性血液病病例,评估植入情况、GVHD情况、感染发生情况、预处理相关毒性及复发率和生存率。全部病人移植前签署知情同意书,随访终止时间为2014年3月12日,中位随访时间20.5(16.3-27.3)个月。结果表明,30例病人均获得100%植入,无预处理相关脏器衰竭发生及死亡事件,II-IV度aGVHD累积发生率为37.9%,其中III-IV度重度GVHD发生率为3.4%,慢性广泛型GVHD发生率为13.8%,复发1例,移植后1例出现移植排斥现象,1例出现移植物功能不良,死亡2例(6.7%),均死于植活后感染。1年生存率为93.3%,1年无病生存率为83.3%。结论:清肿瘤化疗方案联合低强度改良预处理方案用于异基因造血干细胞移植治疗恶性血液病初步结果为安全有效,对于减少血液恶性肿瘤移植后的复发具有一定的作用。

This study was aimed to investigate the safety and effectiveness of tumor-ablative Chemotherapy combined with low intensity conditioning regiment BUCy/TBICy for patients with hematologic malignancies receiving aUogeneic hematopoietic stem cell transplantation （allo-HSCT）. The clinical data of 30 patients with hematologic malignancies received above-mentioned therapeutic method from January 2012 to January 2013 was analyzed restropectively, and the en- graftment, GVHD, infection, conditioning-related toxicity, relapse and survival rates were evaluated. All the patients signed the informed consent before transplantation. The median follow-up duration was 20.5 （ 16.3 - 27.3 ） months. The results indicated that all the patients had been engrafted successfully. One year overall survival（ OS ） and disease-free sur- vival（DFS） rates were 93.3% and 83.3% respectively. No conditioning-related toxicity occurred. The incidences of II - IV grade aGVHD was 37.9%, among which incidence of III- IV grade aGVHD was 3.4% ; incidence of extensive cGVHD was 13.8%. So far, 1 case relapsed, 1 case displayed graft rejection, and poor function of graft occured in 1 case, death occured in 2 cases（6.7% ）. It is concluded that tumor-ablative chemotherapy combined with low intensity- modified BUCy/TBICy is safe and effective in allogeneic hematopoietic stem cell transplantation for hematologic malig- nancies, and it is useful to reduce relapse of hematologic malignancies after transplantation.