FAC联合Bu改良预处理方案对重型再生障碍性贫血患者移植疗效的影响

Effects of FAC combined with Bu conditioning for SAA patients undergoing allogeneic stem cell transplantation

目的观察FAC联合Bu改良预处理方案对重型再生障碍性贫血(severe aplastic anemia,SAA)异基因造血干细胞移植疗效的影响。方法收集我院2016年1月至2021年9月期间收治的行异基因造血干细胞移植的28例SAA患者的临床资料,按照预处理方案不同将患者分为两组:FAC方案预处理组和FAC+Bu预处理组,观察两组患者预处理的毒副反应、造血植入、移植后急慢性移植物抗宿主病(graft versus host disease,GVHD)、病毒感染、肝静脉闭塞病(VOD)发生率及无进展生存期(progression free survival,PFS)、总体生存期(overall survival,OS)的差异。结果两组患者在年龄、性别、体能状况、患病距离移植时间、供受者性别关系、移植类型、输注骨髓有核细胞、单个核细胞(mononuclear cell,MNC)及CD34+细胞之间差异无统计学意义(P>0.05),具有可比性。与FAC组相比,FAC+Bu组患者预处理后幻听幻视副反应增加,移植后混合嵌合发生率降低,血小板重建时间缩短,移植后Ⅲ-Ⅳ度aGVHD发生率增加,3年PFS及OS差异无统计学意义。结论FAC联合Bu改良预处理方案促进植入,降低混合嵌合发生率,但并未改善患者整体生存。

Objective To observe the effects of FAC combined with Bu conditioning for severe aplastic anemia(SAA)patients undergoing allogeneic hematopoietic stem cell transplantation.Methods The data of 28 SAA patients who underwent allogeneic hematopoietic stem cell transplantation in our hospital from January 2016 to September 2021 were collected and analyzed.The patients were divided into two groups:FAC conditioning group and FAC+Bu conditioning group.We observed the side effects of conditioning regimen,hematopoietic recovery,acute and chronic graft versus host disease(GVHD),viral infection,incidence of venous obstructive disease(VOD),progression free survival(PFS),and overall survival(OS).Results There was no significant difference between the two groups in age,gender,physical condition,history of disease,gender relationship between donors and recipients,transplantation type,infusion of bone marrow nucleated cells,MNC or CD34 positive cells(P>0.05).Compared with those in FAC group,the side effects of auditory hallucination and visual hallucination in FAC+Bu group increased,the incidence of mixed chimerism decreased,the time of platelet reconstruction shortened,the incidence of gradeⅢ-ⅣaGVHD increased.However,3-year PFS or OS did not significantly differ between the two groups.Conclusion FAC combined with Bu conditioning regimen promotes implantation and reduces mixed chimerism.However,it does not improve patients’overall survival.