摘要
目的研究异基因造血干细胞移植(allo-HSCT)治疗进展期难治性急性髓系白血病(AML)的临床疗效。方法收集2002年5月至2011年6月苏州大学附属第一医院血液科收治的17例未缓解期难治性AML患者,采用改良马利兰+环磷酰胺(12例)或全身放疗+环磷酰胺(5例)的清髓性预处理方案行allo-HSCT,采用环孢菌素A(CsA)加短程氨甲蝶呤(MTX)预防移植物抗宿主病(GVHD),部分患者加入霉酚酸酯(MMF)。结果 15例成功获得造血重建,中性粒细胞>1.0×109/L和血小板>20×109/L的中位时间分别为12.5(11～14)d和12.5(10～15)d。急性GVHD发生率为53.3%(8/15),可评估的9例中,5例发生慢性GVHD,均为局限性。移植相关病死率为29.4%(5例),移植后成功获得完全缓解的14例中6例血液学复发,其中2例合并髓外复发,复发率为42.9%。中位随访5(0～71)个月,至今有6例无病生存(DFS),2年DFS为35.3%。结论 Allo-HSCT治疗进展期难治性AML仍不失为一种有效的挽救手段,其中发生慢性GVHD的患者预后较好,而移植相关并发症及移植后复发是影响患者生存的主要因素。
Objective To investigate the clinical efficacy of allogeneic hematopietic stem cell transplantation （allo-HSCT） in treatment of refractory acute myeloid leukemia （AML）. Methods Between May 2002 and June 2011,17 patients with refractory AML and without remission registered in Department of hematology, the First Affiliated Hospital of Suzhou Univer- sity were performed allo-HSCT by myeloablative pre-processing scheme through using improved busulfan/cyclophosphamide （ n = 12） or total-body irradiation ＋ cyclophosphamide（ n = 5 ） ,followed by cyclosporine A （CsA） ＋ short term MTX for prevention of graft versus host disease （GVHD）. Futhermore, mycophenolate mofetil（MMF） was also added in part of pa- tients. Results Hemopoiesis was successfully reconstructed in 15 patients,with median times of neutrophil 〉 1.0 ×10^9/L and.platelet 〉 20 ×10^9/L being 12. 5 （ 11 - 14） d and 12. 5 （ 10 - 15 ） d, respectively. The incidence of acute GVHD was 53.3% （8/15）. Of 9 evaluable patients,5 cases of chronic GVHD were all limited. The transplantation-related mortality was 29. 4% （n = 5 ）. Among the 14 patients with complete remission after transplantation,6 patients were found with hematolog- ic relapse, and 2 patients with combined extramedullary relapse, with the relapse rate being 42. 9 %. The median follow-up of 5 （ 0 ~ 71 ） months,6 patients were found to have diseasefree survival （DFS） till now, with 2 years＇ DFS being 35.3 %. Con- clusion Allo-HSCT was still an effective salvage therapy for advanced refractory AML. Notably,patients with cGVHD had a better prognosis, and transplant-related complications and recurrence after transplantation were critical factors to affect the survival of patients.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2012年第4期297-299,共3页
Chinese Journal of Practical Internal Medicine
基金
江苏省"科教兴卫"工程医学重点人才资助项目(RC2007072)
江苏省人事厅"六大人才高峰"资助项目(07-B-019)
苏州市国际科技合作项目(SWH0815)
苏州市科技计划应用基础项目(YJS0912)
江苏省政府留学基金资助
关键词
造血干细胞移植
异基因
白血病
hematopietic stem cell transplantation
allogene
leukemia
