小剂量地西他滨联合异基因造血干细胞分次输注治疗老年骨髓增生异常综合征转急性髓性白血病2例报告

Low-dose decitabine combined with fractional allogeneic hematopoietic stem cell transfusion for treatment of elderly patients with acute myeloid leukemia transformed from myelodysplastic syndrome: a report of 2 cases

目的观察小剂量地西他滨联合异基因造血干细胞分次输注(微移植)治疗老年骨髓增生异常综合征转急性髓性白血病(MDS-AML)的疗效。方法对2例确诊为MDS-AML患者分别予小剂量地西他滨或地西他滨联合CAG方案(阿糖胞苷+阿克拉霉素)化疗加微移植治疗,供者为人类白细胞抗原半相合的患者子女,采集重组人粒细胞集落刺激因子动员后的供者外周血干细胞,于化疗结束后约36 h分次输注。观察患者疾病状态、血小板水平、生存时间及不良反应情况。结果病例1、病例2治疗后复查骨髓均未缓解,生存时间分别为2个月和4个月。病例1治疗后血小板明显上升,最高达59×109/L,未输注血小板;病例2治疗后血小板输注间隔时间延长,并逐步脱离血小板输注。2例患者均未出现移植物抗宿主病。结论对于老年MDS-AML患者,小剂量地西他滨联合微移植虽不能达到治愈目的,但可延长生存期、提高血小板、改善患者的生活质量。

Objective To explore the efficay of low-dose decitabine combined with fractional allogeneic hematopoietic stem cell transfusion（ micro transplantation） for treatment of elderly patients with acute myeloid leukemia transformed from myelodysplastic syndrome （ MDS-AML） .Methods Two patients diagnosed as MDS-AML were treated with chemotherapy regimen of low-dose decitabine or decitabine combined with CAG（cytosine arabinoside＋aclacinomycin） and micro transplantation.The donors were children of patients with human leukocyte antigen semi-matched.Peripheral blood stem cells from the donors were mobilized with granulocyte colony-stimulating factor and then collected. Patients transfused PBSC about 36 hours after the chemotherapy finished.The disease status,platelet levels,survival timeand side effects were observed.Re sults Two cases did not achieve complete response.The survival times of Case 1 and Case 2 were 2 months and 4 months respectively. The platelet level in Case 1 increased remarkably after treatment,and reached to the maximal level of 59 ×10^9/L.No platelet transfusion was observed in Case 1.In Case 2,the interval of platelet transfusion was prolonged,and the patient was gradually independent on platelet transfusions. No graft-versus-host disease occurred in the two patients.Conclusion For elderly patients with MDS-AML,low-dose decitabine combined with micro transplantation can not cure the disease,but can prolong the survival time,increase the level of platelet and improve the quality of life.