George B, Mathews V, Viswabandya A, Kavitha M L, Srivastava A, Chandy M
Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India.
Bone Marrow Transplant. 2007 Jul;40(1):13-8. doi: 10.1038/sj.bmt.1705669. Epub 2007 Apr 23.
Thirty-five patients (25 men and 10 women) with a median age of 20 years with severe aplastic anaemia (SAA) underwent HLA identical stem cell transplantation (HSCT) using a combination of fludarabine and cyclophosphamide +/- anti-thymocyte globulin between 2004 and 2006. Cyclosporine and mini methotrexate were used as GVHD prophylaxis. Graft source included peripheral blood stem cells (28) or G-CSF stimulated bone marrow (7). Two patients expired < 7 days post-HSCT while 32 (91.5%) patients engrafted with a median neutrophil and platelet engraftment time of 12 days each. Three patients (8.5%) developed veno-occlusive disease while acute GVHD occurred in 29% of evaluable patients, with chronic GVHD in 32%. At a mean follow-up of 22 months, 29 (82.8%) are alive and well. When compared with 26 patients previously transplanted using Cy200/antilymphocyte globulin, there was faster neutrophil engraftment (12 vs 16 days; P = 0.002) with significantly lower rejection rates (2.9 vs 30.7%; P = 0.003) and a superior event-free (82.8 vs 38.4%; P = 0.001) and overall survival (82.8 vs 46.1%; P = 0.005). A combination of fludarabine with cyclophosphamide +/- anti-thymocyte globulin reduces rejection and improves overall and event-free survival in Indian patients undergoing HSCT for severe aplastic anaemia.
2004年至2006年间，35例（25例男性和10例女性）中位年龄为20岁的重型再生障碍性贫血（SAA）患者接受了HLA配型相合的干细胞移植（HSCT），移植方案采用氟达拉滨与环磷酰胺联合应用，部分患者加用抗胸腺细胞球蛋白。环孢素和小剂量甲氨蝶呤用于预防移植物抗宿主病（GVHD）。移植物来源包括外周血干细胞（28例）或粒细胞集落刺激因子（G-CSF）动员的骨髓（7例）。2例患者在HSCT后7天内死亡，32例（91.5%）患者成功植入，中性粒细胞和血小板植入的中位时间均为12天。3例患者（8.5%）发生了静脉闭塞性疾病，29%的可评估患者发生了急性GVHD，32%的患者发生了慢性GVHD。平均随访22个月时，29例（82.8%）患者存活且状况良好。与先前使用环磷酰胺200/抗淋巴细胞球蛋白进行移植的26例患者相比，本研究患者中性粒细胞植入更快（12天对16天；P = 0.002），排斥率显著降低（2.9%对30.7%；P = 0.003），无事件生存率（82.8%对38.4%；P = 0.001）和总生存率（82.8%对46.1%；P = 0.005）更高。对于因重型再生障碍性贫血接受HSCT的印度患者，氟达拉滨与环磷酰胺联合应用，部分患者加用抗胸腺细胞球蛋白，可降低排斥反应，提高总生存率和无事件生存率。
