Yuan Xiao, Sun Zi-Min, Liu Hui-Lan, Geng Liang-Quang, Wang Zu-Yi, Tong Juan, Yao Wen
Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei 230001, Anhui Province, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2008 Jun;16(3):614-7.
This study was aimed to investigate the therapeutic efficiency and complications after allo-hematopoietic stem cell transplantation (allo-HSCT) with reduced-intensity conditioning regimens in hematologic malignancies. 10 patients (6 CML patients, 2 AML patients, 1 ALL patient and 1 NHL patient) underwent related allogeneic hematopoietic stem cell transplantation with reduced-intensity conditioning regimens. The conditioning regimens consisted of "FLU + CY + TBI" basically and was appropriately improved in accordance with status of patients. Cyclosporin A (CsA) and mycophenolate mofetil (MMF) were used to prevent the graft-versus-host disease (GVHD). Detection of bone marrow cells, chromosomes, fused gene, ABO blood group and STR-PCR were used to observe engraftment, relapse, GVHD, transplantation- related complications (TRC) after transplantation and to evaluate patients quality of life. The results showed that the 10 patients successfully accepted the transplantation and their primary diseases were cured. In one patient, severe pulmonary infection happened, and in another one CMV infection occurred. Grade IV of acute GVHD occurred in one case and grade I of acute GVHD in 2 cases, the no chronic GVHD appeared. 5 patients relapsed after transplantation at various time points, the donor lymphocytes infusion (DLI) or drugs rescued these 5 patients. During median follow-up of 5 - 35 months, 2 out of which died, 8 survived, the overall survival rate was 80%, and the survivors live in a high-quality life. In conclusion, the hematopoietic stem cell transplantation with reduced intensity conditioning regimens was feasible with relatively low toxicity for recipients. GVHD and TRC were low, and life quality of patients after transplantation was high. DLI could cure the primary diseases even relapsed after transplantation.
本研究旨在探讨采用减低剂量预处理方案进行异基因造血干细胞移植（allo-HSCT）治疗血液系统恶性肿瘤的疗效及并发症。10例患者（6例慢性粒细胞白血病患者、2例急性髓系白血病患者、1例急性淋巴细胞白血病患者和1例非霍奇金淋巴瘤患者）接受了采用减低剂量预处理方案的亲缘异基因造血干细胞移植。预处理方案基本由“氟达拉滨+环磷酰胺+全身照射”组成，并根据患者情况适当调整。使用环孢素A（CsA）和霉酚酸酯（MMF）预防移植物抗宿主病（GVHD）。通过检测骨髓细胞、染色体、融合基因、ABO血型和STR-PCR来观察移植后的植入情况、复发情况、GVHD、移植相关并发症（TRC），并评估患者的生活质量。结果显示，10例患者均成功接受移植，原发病均获治愈。1例患者发生严重肺部感染，另1例发生巨细胞病毒感染。1例发生Ⅳ度急性GVHD，2例发生Ⅰ度急性GVHD，未出现慢性GVHD。5例患者移植后不同时间点复发，经供者淋巴细胞输注（DLI）或药物挽救。中位随访5 - 35个月，其中2例死亡，8例存活，总生存率为80%，存活者生活质量高。综上所述，采用减低剂量预处理方案的造血干细胞移植对受者毒性相对较低，是可行的。GVHD和TRC发生率低，移植后患者生活质量高。DLI可治愈移植后复发的原发病。
