Basara N, Roemer E, Kraut L, Guenzelmann S, Schmetzer B, Kiehl M G, Fauser A A
Clinic for Bone Marrow Transplantation and Hematology/Oncology, Idar-Oberstein, Germany.
Bone Marrow Transplant. 2002 Nov;30(10):651-9. doi: 10.1038/sj.bmt.1703697.
According to recent reports, fast engraftment with minimal transplant-related toxicity and mortality (TRT, TRM) can be achieved by using reduced-intensity preparative regimens in allogeneic hematopoietic stem cell transplantation (HSCT). We report our experience with related (39%) and unrelated (61%) HSCT in 44 high risk patients (AML, ALL, CML, CLL) receiving either busulfan/fludarabine or busulfane/fludarabine/ATG or TBI/fludarabine as reduced-intensity preparative regimens. Organ toxicity was minimal with mild mucositis and no major bleeding. Acute GVHD was recorded in 64% of the patients. Twenty-three patients achieved complete remission after transplantation, and complete chimerism was obtained in all patients with stable engraftment (35 patients). Twenty-nine patients died: 15 due to relapse/progression, 14 due to TRM. Survival with median follow-up of 18.5 months was significantly better in patients with matched related transplants compared to patients with other transplants. However, there was no difference between related and unrelated transplants with regard to engraftment, TRM and GVHD. In conclusion, our results in high-risk patients transplanted in CR or with smoldering leukemia from a related donor are encouraging, although a longer follow-up and a larger group of patients is needed in order to evaluate the role of different reduced-intensity preparative regimens in unrelated and related HSCT.
根据最近的报告，在异基因造血干细胞移植（HSCT）中使用低强度预处理方案可实现快速植入，且移植相关毒性和死亡率（TRT，TRM）极低。我们报告了44例高危患者（急性髓系白血病、急性淋巴细胞白血病、慢性髓性白血病、慢性淋巴细胞白血病）接受白消安/氟达拉滨或白消安/氟达拉滨/抗胸腺细胞球蛋白或全身照射/氟达拉滨作为低强度预处理方案进行相关（39%）和无关（61%）HSCT的经验。器官毒性极小，仅有轻度黏膜炎，无严重出血。64%的患者发生了急性移植物抗宿主病（GVHD）。23例患者移植后获得完全缓解，所有植入稳定的患者（35例）均实现了完全嵌合。29例患者死亡：15例死于复发/病情进展，14例死于TRM。中位随访18.5个月时，与其他移植患者相比，匹配的相关移植患者的生存率显著更高。然而，在植入、TRM和GVHD方面，相关移植和无关移植之间没有差异。总之，我们对处于完全缓解期或患有冒烟型白血病的高危患者进行相关供体移植的结果令人鼓舞，不过为了评估不同低强度预处理方案在无关和相关HSCT中的作用，还需要更长时间的随访和更大规模的患者群体。
