异基因造血干细胞移植治疗难治性急性白血病

ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION FOR REFRACTORY ACUTE LEUKEMIA

目的：观察异基因造血干细胞移植(Allo-HSCT)对未缓解期白血病患者的疗效。方法：4例难治性白血病，其中13例耐药复发，1例继发性白血病，经常规化疗2个-10个疗程未能达到缓解。供、受者HLA配型不全相合1例，其余3例完全相合。预处理方案：Bu／Mal1例，Bu/Cy3例(其中2例ALL加用ACNU)。GVHD预防：CsA+短程MTX，2例加用MMF，1例HLA不全相合者加用ATG和MMF。输入的单个核细胞数(8．05～13．65)×10^8/Kg。结果：4例造血细胞均成功植入，ANC>0．5×10^9/L的中位时间为12d，血小板>50×10^9/L的中位时间为22．5d；基因型完全转换成供者型的中位时间为15d;3例供、受者红细胞血型不合者分别于35d、38d、26d转变成供者血型。4例移植后均获CR，骨髓象完全缓解的中位时间为20．5d。除1例因GVHD死亡外，其余3例迄今均无白血病生存。结论：Allo-HSCT对于难活性白血病是有效的治疗选择。

Objective: To explore the clinical effect of allogeneic hematopoietic stem cell transplantation(Allo- HSCT) for patients with acute leukemia non- responding to a series of intensive courses of chemotherapy. Methods: Of 4 patients with advanced high- risk leukemia eligible for allo- HSCT,three were relapsed and refractory,one were HLA- matched siblings in 3 cases and partially mismatched relative in one.The conditioning regimen consisted of Bu/Cy in three and Bu/Mal in one. GVHD prophylaxis consisted of CsA, MTX and MMF in the majority of patients. Results: All patients in the study group achieved successful engraftment and complete donor chimerism at a median of 12 days(range: 11~14 days)and 15 days(11~24 days),respectively,complete remission was achieved of 20.5 day (range:15~27 days).Moderate but acceptable toxicity was noticed given the conditioning regimen. Acute graft versus host disease(aGVHD) was observed in 2 cases,one grade I and the other grade IV. A patient died from grade IV aGVHD at day 64 of transplantation and the others are alive and leukemia- free survival at 345,174,77 days after allo- HSCT,respectively. Conclusion: Allo- HSCT is the only treatment option for refractory and relapsed leukemia to offer long- term disease- free survival and possible cure.