Mori T, Aisa Y, Nakazato T, Yamazaki R, Shimizu T, Mihara A, Yamane A, Ikeda Y, Okamoto S
Department of Medicine, Division of Hematology, Keio University School of Medicine, Shinjuku-ku, Tokyo 160-8582, Japan.
Transplant Proc. 2007 Jun;39(5):1615-9. doi: 10.1016/j.transproceed.2006.12.042.
Eighteen patients with hematologic malignancies underwent cord blood transplantation (CBT) from unrelated donors after being conditioned with myeloablative or reduced-intensity regimens, and received tacrolimus and methotrexate (15 mg/m(2) on day 1, 10 mg/m(2) on days 3 and 6) as graft-versus-host disease (GVHD) prophylaxis. The median number of nucleated cells in infused cord blood was 2.66 x 10(7)/kg (range 1.90 to 4.15 x 10(7)/kg). Engraftment was achieved in 16 of 18 patients. The median time to absolute neutrophil count >0.5 x 10(9)/L was 21.5 days (range 17 to 32), and the median time to platelet count >2.0 x 10(9)/L was 36 days (range 26 to 57). Of the 16 evaluable patients, five and eight had grades I and II acute GVHD, respectively, and none had grades III/IV acute GVHD. The cumulative incidence of grade II acute GVHD was 44.4%. Chronic GVHD occurred in 7 of 15 evaluable patients: limited type in three patients, extensive type in four patients. Of the 18 patients, 14 were alive and disease-free between 173 and 1514 days after CBT (median 746 days). The probability of disease-free survival at 2 years was 79.1%. These results, although in a retrospective study, suggested that tacrolimus and short-term methotrexate effectively prevented the occurrence of severe acute GVHD after unrelated CBT, and may contribute to a high survival rate.
18例血液系统恶性肿瘤患者在接受清髓或减低强度预处理后，接受了来自无关供者的脐血移植（CBT），并接受他克莫司和甲氨蝶呤（第1天15mg/m²，第3天和第6天10mg/m²）预防移植物抗宿主病（GVHD）。输注脐血中核细胞的中位数为2.66×10⁷/kg（范围1.90至4.15×10⁷/kg）。18例患者中有16例实现了造血重建。绝对中性粒细胞计数>0.5×10⁹/L的中位时间为21.5天（范围17至32天），血小板计数>2.0×10⁹/L的中位时间为36天（范围26至57天）。在16例可评估的患者中，分别有5例和8例发生了Ⅰ级和Ⅱ级急性GVHD，无Ⅲ/Ⅳ级急性GVHD。Ⅱ级急性GVHD的累积发生率为44.4%。15例可评估患者中有7例发生慢性GVHD：3例为局限性，4例为广泛性。18例患者中，14例在CBT后173至1514天存活且无疾病（中位746天）。2年无病生存率为79.1%。这些结果，尽管是一项回顾性研究，提示他克莫司和短期甲氨蝶呤可有效预防无关供者CBT后严重急性GVHD的发生，并可能有助于提高生存率。
