Graef Thorsten, Kuendgen Andrea, Fenk Roland, Zohren Fabian, Haas Rainer, Kobbe Guido
Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Moorenstr. 5, 40225 Düsseldorf, Germany.
Leuk Res. 2007 Feb;31(2):257-9. doi: 10.1016/j.leukres.2006.03.003. Epub 2006 Apr 18.
Therapeutic options for patients with relapse of MDS or high risk AML after allogeneic stem cell transplantation are limited. We here present the case of a 64-year-old female patient with MDS, who received peripheral blood stem cells from her HLA-identical brother after a non-myeloablative conditioning regimen. Two months after allogeneic transplantation she suffered from a relapse, now fulfilling WHO criteria for AML with a bone marrow blast count of 91%. We then decided to treat her with azacitidine, a DNA methyltransferase inhibitor with proven antileukemic activity. The patient achieved a complete haematological response after two cycles and full donor chimerism after a single dose of donor lymphocytes. We postulate that azacitidine acts through a direct reduction of malignant cells and may in addition augment the immunologic effects of donor lymphocyte infusions.
异基因干细胞移植后复发的骨髓增生异常综合征（MDS）或高危急性髓系白血病（AML）患者的治疗选择有限。我们在此报告一例64岁的MDS女性患者，她在接受非清髓性预处理方案后，从其 HLA 相同的哥哥那里接受了外周血干细胞。异基因移植两个月后，她病情复发，此时骨髓原始细胞计数为91%，符合世界卫生组织（WHO）的AML标准。然后我们决定用阿扎胞苷治疗她，阿扎胞苷是一种已证实具有抗白血病活性的DNA甲基转移酶抑制剂。患者在两个疗程后达到完全血液学缓解，在单次输注供体淋巴细胞后实现完全供体嵌合。我们推测阿扎胞苷通过直接减少恶性细胞发挥作用，此外还可能增强供体淋巴细胞输注的免疫效应。
