摘要
目的探讨小剂量地西他滨用于高危急性淋巴细胞白血病(ALL)异基因造血干细胞移植(allo-HSCT)后维持治疗的疗效和安全性.方法收集2016年7月至2018年3月于郑州大学第一附属医院行allo-HSCT的10例高危ALL并在移植后给予小剂量地西他滨维持治疗的患者资料,分析其移植后复发和移植物抗宿主病(GVHD)的发生情况并评估该方案的安全性,同时使用Kaplan-Meier法分析累积复发率、无病生存(DFS)率和总生存(OS)率.结果共2例患者复发,10例患者的中位复发时间为移植后575 d,1年累积复发率16.7%,1年OS率100.0%,1年DFS率83.3%.2例伴p53突变患者截至随访结束移植后DFS时间分别达23个月和11个月.未观察到因使用地西他滨而诱发或减轻GVHD的现象.9例患者发生Ⅰ~Ⅱ级骨髓抑制.3例发生移植后不明原因血小板减少,地西他滨治疗后血小板均恢复正常.结论小剂量地西他滨维持治疗血液学不良反应小,在不增加GVHD的同时,可作为高危ALL患者移植后预防复发的维持治疗选择.
Objective To investigate the efficacy and safety of maintenance treatment with low-dose decitabine after allogeneic stem cell transplantation (allo-HSCT) for high-risk acute lymphoblastic leukemia (ALL). Methods The data of 10 patients with high-risk ALL who received maintenance therapy with low-dose decitabine after allo-HSCT in the First Affiliated Hospital of Zhengzhou University from July 2016 to March 2018 was collected. The incidence of post-transplant relapse and graft-versus-host disease (GVHD) and the safety of the treatment protocol were analyzed. The cumulative incidence of relapse (CIR) rate, disease-free survival (DFS) rate and overall survival (OS) rate were estimated by Kaplan-Meier method. Results Two patients relapsed and the median relapse time of these 10 patients was 575 days after transplantation. The 1-year CIR, OS and DSF rates were 16.7%, 100.0% and 83.3%, respectively. At the end of follow-up, the DFS time after transplantation of 2 patients with p53 mutation were 23 months and 11 months, respectively. There was no induction or alleviation of GVHD caused by decitabine treatment. Nine patients developed grade Ⅰ-Ⅱmyelosuppression. Three patients had unexplained thrombocytopenia after transplantation and their platelet counts recovered after decitabine treatment. Conclusion Maintenance therapy with low-dose decitabine has low hematologic toxicity without increasing GVHD, which could be a maintenance treatment option to prevent relapse after transplantation for patients with high-risk ALL.
作者
刘佳
谢新生
万鼎铭
曹伟杰
邢海洲
姜中兴
孙玲
丁文稳
董振坤
刘延方
孙慧
郭荣
Liu Jia;Xie Xinsheng;Wan Dingming;Cao Weijie;Xing Haizhou;Jiang Zhongxing;Sun Ling;Ding Wenwen;Dong Zhenkun;Liu Yanfang;Sun Hui;Guo Rong(Department of Hematology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《白血病.淋巴瘤》
CAS
2019年第8期473-478,共6页
Journal of Leukemia & Lymphoma
基金
国家自然科学基金(81070445)
河南省自然科学基金(182300410301)。
关键词
白血病
淋巴细胞
急性
异基因造血干细胞移植
复发
小剂量地西他滨
Leukemia,lymphocytic,acute
Allogeneic hematopoietic stem cell transplantation
Recurrence
Low-dose decitabine