地西他滨桥接异基因造血干细胞移植治疗骨髓增生异常综合征的疗效分析

Retrospective efficacy analysis of decitabine bridging allogeneic hematopoietic stem cell transplantation on the treatment of myelodysplastic syndrome

目的 评价地西他滨桥接异基因造血干细胞移植（allo-HSCT）治疗骨髓增生异常综合征（MDS）的疗效及安全性.方法 回顾性分析2010年7月至2013年12月于苏州大学附属第一医院血液科接受allo-HSCT的MDS患者的临床特征及疗效,随机抽取25例接受地西他滨桥接allo-HSCT的MDS患者为桥接组,以同期33例未接受地西他滨行allo-HSCT的MDS患者为对照组,观察患者疗效、总生存（OS）及移植物抗宿主病（GVHD）发生情况.结果 桥接组患者移植前骨髓完全缓解率为64.0％（25例中16例）,明显高于对照组的15.1％（33例中5例）,差异有统计学意义（P＜0.05）;早期移植相关死亡率低于对照组（4.0％对18.2％）,但差异无统计学意义（P=0.106）.桥接组移植相关死亡率及2年OS率分别为12.0％及83.0％,与对照组的30.3％及59.0％比较差异均有统计学意义（P值均＜0.05）.桥接组14例患者发生急性GVHD（aGVHD）,其中Ⅰ度7例、Ⅱ度3例、Ⅲ度4例;对照组16例患者发生aGVHD,其中Ⅰ度7例、Ⅱ度8例、Ⅲ度1例.结论 地西他滨桥接allo-HSCT治疗MDS安全且有效.

Objective To evaluate the efficacy of decitabine （DAC） bridging therapy followed by allogeneic hematopoietic stem cell transplantation （allo-HSCT） in patients with myelodysplastic syndrome （MDS）.Methods The clinical characteristics and curative effect of MDS patients who received allo-HSCT from 2010 July to 2013 December were retrospectively analyzed.Of them,25 MDS patients who received decitabine bridging allo-HSCT were randomly selected （referred to as the bridging group）,while at the same time another 33 MDS patients who did not receive decitabine for allo-HSCT in MDS were also randomly selected as control group.The effect of decitabine bridging allo-HSCT on the patients＆#39; survival and occurrence of graft versus host disease （GVHD） was analyzed.Results With decitabine bridge therapy,64.0% patients （16/25） achieved marrow complete remission before allo-HSCT,while the control group was only 15.1% （5/33,P〈0.05）.Decitabine bridging group of early transplant-related mortality was lower than that of the control group （4.0% vs 18.2%）,but the difference was not statistically significant （P=0.106）.Up to follow-up deadline,the mortality of decitabine bridging group was 12.0%,while that of the control group was 30.3% （P〈0.05）.The 2-year OS of decitabine bridging group was 83.0%,while that of the control group was 59.0% （P〈0.05）.Of the 14 patients in decitabine bridging group with aGVHD,7 was grade Ⅰ aGVHD,3 grade Ⅱ and 4 grade Ⅲ.Of the 16 patients in control group with aGVHD,7 was grade Ⅰ aGVHD,8 grade Ⅱ and 1 grade Ⅲ.Conclusion Decitabine bridging therapy followed by allo-HSCT in the treatment of MDS is safe and effective.