Hong J Y, Choi M K, Kim D H, Kim S J, Kim K, Kim W S, Chung C W, Kim H O, Min Y H, Jang J H
Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Transplant Proc. 2010 Nov;42(9):3723-8. doi: 10.1016/j.transproceed.2010.09.005.
This study was performed to determine the feasibility of second hematopoietic stem cell transplantation (HSCT) using reduced-intensity conditioning (RIC) with fludarabine and melphalan in patients with relapsed hematologic malignancies after a prior autologous HSCT. Twelve patients (multiple myeloma [n = 7], non-Hodgkin lymphoma [n = 3], and acute myeloid leukemia [n = 2] received allogeneic HSCT using RIC with fludarabine (25 mg/m(2) for 5 days) and melphalan (140 mg/m(2) for 1 day) after a failed autologous HSCT. The graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine plus a minidose of methotrexate. All patients achieved a neutrophil and platelet engraftment in a median 13.5 days and 17.5 days, respectively. The transplant-related mortality was 2 patients (16.7%). Grade II-IV acute GVHD and chronic extensive GVHD were noted in 4 (33.3%) and 1 patient (11.1%), respectively. Over a median follow-up duration of 376 days, 5 patients were alive without evidence of disease. The estimated nonrelapse mortality at 1 year was 28.4%. The estimated overall survival rate at 1 year was 58.3%, and the estimated event-free survival rate at 1 year was 41.7%. Allogeneic HSCT using RIC with fludarabine and melphalan appears to be feasible for a second HSCT in patients with relapsed hematologic malignancies after a failed autologous HSCT.
本研究旨在确定对于既往自体造血干细胞移植（HSCT）后复发的血液系统恶性肿瘤患者，使用氟达拉滨和马法兰进行减低剂量预处理（RIC）进行第二次造血干细胞移植（HSCT）的可行性。12例患者（多发性骨髓瘤[n = 7]、非霍奇金淋巴瘤[n = 3]和急性髓系白血病[n = 2]）在自体HSCT失败后，接受了使用氟达拉滨（25 mg/m²，共5天）和马法兰（140 mg/m²，共1天）进行RIC的异基因HSCT。移植物抗宿主病（GVHD）预防措施包括环孢素加小剂量甲氨蝶呤。所有患者中性粒细胞和血小板分别在中位时间13.5天和17.5天实现植入。移植相关死亡率为2例患者（16.7%）。分别有4例（33.3%）和1例（11.1%）患者出现Ⅱ - Ⅳ级急性GVHD和慢性广泛性GVHD。在中位随访376天期间，5例患者存活且无疾病证据。1年时估计的非复发死亡率为28.4%。1年时估计的总生存率为58.3%，1年时估计的无事件生存率为41.7%。对于既往自体HSCT失败后复发的血液系统恶性肿瘤患者，使用氟达拉滨和马法兰进行RIC的异基因HSCT似乎是可行的第二次HSCT方案。
