脂质体多柔比星强化预处理方案异基因造血干细胞移植治疗白血病的效果观察

Observation on the efficacy of liposomal doxorubicin intensive preconditioning regimen and allogeneic hematopoietic stem cell transplantation for treatment of leukemia

目的探讨脂质体多柔比星强化预处理方案异基因造血干细胞移植(allo-HSCT)治疗白血病的效果。方法回顾性分析深圳市第二人民医院2016年1月至2017年6月20例应用脂质体多柔比星强化预处理方案allo-HSCT患者的资料。分析患者移植效果、并发症发生情况及预后。结果白细胞植活中位时间17 d(13~23 d),血小板植活中位时间22.5 d(最短13 d,最长>90 d)。急性移植物抗宿主病(GVHD)和慢性GVHD分别有2例和1例;出血性膀胱炎8例,EB病毒血症15例,巨细胞病毒血症8例,败血症1例,急性肝损伤1例,真菌性肺炎2例。中位随访31.7个月(0.8~53.8个月),1例患者移植后第25天发生颅内感染而死亡;3例患者随访期内复发,其中2例死亡;其余16例患者随访期复查均为100%供者基因。结论脂质体多柔比星强化预处理方案allo-HSCT治疗白血病效果较好,提高预处理强度未增加治疗相关不良反应。EB病毒、巨细胞病毒血症发生率虽然较高,但积极治疗后均好转。

Objective To investigate the efficacy of liposomal doxorubicin intensive preconditioning regimen and allogeneic hematopoietic stem cell transplantation(allo-HSCT)in treatment of leukemia.Methods The data of 20 patients with intensive preconditioning regimen allo-HSCT who were admitted to Shenzhen Second People's Hospital from January 2016 to June 2017 were retrospectively analyzed.The transplantation effect,occurrence of complications and prognosis of patients were analyzed.Results The median time of granulocyte engraftment was 17 d(13-23 d);the median time of platelet engraftment was 22.5 d(minimum 13 d,maximum>90 d).The acute graft-versus-host disease(GVHD)and chronic GVHD occurred in 2 cases and 1 case,respectively.Eight cases occurred hemorrhagic cystitis,15 cases occurred Epstein-Barr viremia,8 cases occurred cytomegaloviremia,1 case occurred sepsis,1 case occurred acute liver injury,and 2 cases occurred fungal pneumonia.The median follow-up time was 31.7 months(0.8-53.8 months).One patient died of intracranial infection on the 25th day after transplantation;3 patients relapsed during the follow-up period,and 2 of them died;the other 16 patients carried 100%donor genes during the follow-up period.Conclusions The liposomal doxorubicin intensive preconditioning regimen and allo-HSCT have a good effect on leukemia.Increasing the intensity of pretreatment does not increase the treatment-related adverse reactions.The incidence rates of Epstein-Barr viremia and cytomegaloviremia are high,but they are improved after active treatment.