Leon Rodriguez Eucario, Rivera Franco Monica M, Perez Alvarez Sandra I
Stem Cell Transplantation Program, Hematology and Oncology Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
Internal Medicine Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
Ann Hematol. 2017 Sep;96(9):1525-1531. doi: 10.1007/s00277-017-3056-0. Epub 2017 Jul 9.
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the ideal treatment for several diseases. However, the morbidity and mortality associated with the procedure might limit its widespread use; therefore, we implemented reduced BUCY2 as conditioning method along with the use of G-CSF-primed bone marrow (G-BM) in order to reduce complications, including graft-versus-host-disease (GVHD), and to improve survival in these patients. An analysis of transplant characteristics, complications, and survival of patients undergoing an allo-HSCT using this conditioning regimen (busulfan 12 mg/kg and cyclophosphamide 80 mg/kg) plus G-BM was performed. Forty patients were included from 1999 to 2015. All of them had a HLA-matched donor, with a median age of 32 years (range 16-59), and 55% were male. The most frequent diagnosis was myelodysplastic syndrome (MDS) in 14 patients (35%), followed by acute lymphoid leukemia (ALL) in 12 (30%). The mean of CD34+ was 2.09 × 106/kg. The mean time to neutrophil and platelet recovery was 20 and 18 days, respectively. The most common toxicity was mucositis (75%) with grade III-IV in 53% of cases. Acute GVHD appeared in 12.5 and 35% of patients developed chronic GVHD. Transplant-related mortality (TRM) was 10%. Five-year relapse-free survival was 69%, and the 5-year overall survival was 69.5%. Our conditioning method along with G-BM preserves an immunosuppressive and myeloablative effect allowing eradication of the malignant clone and achieving adequate bone marrow engraftment with acceptable toxicity, low incidence of GVHD, and low TRM, representing a favorable alternative for allo-HSCT.
异基因造血干细胞移植（allo-HSCT）是多种疾病的理想治疗方法。然而，该手术相关的发病率和死亡率可能会限制其广泛应用；因此，我们采用降低强度的BUCY2方案作为预处理方法，并联合使用粒细胞集落刺激因子动员的骨髓（G-BM），以减少并发症，包括移植物抗宿主病（GVHD），并提高这些患者的生存率。我们对采用该预处理方案（白消安12mg/kg和环磷酰胺80mg/kg）加G-BM进行allo-HSCT的患者的移植特征、并发症和生存率进行了分析。1999年至2015年共纳入40例患者。他们均有人类白细胞抗原（HLA）匹配的供者，中位年龄32岁（范围16 - 59岁），55%为男性。最常见的诊断是骨髓增生异常综合征（MDS），共14例（35%），其次是急性淋巴细胞白血病（ALL），共12例（30%）。CD34+细胞的平均数量为2.09×10⁶/kg。中性粒细胞和血小板恢复的平均时间分别为20天和18天。最常见的毒性反应是黏膜炎（75%），其中53%为III - IV级。12.5%的患者发生急性GVHD，35%的患者发生慢性GVHD。移植相关死亡率（TRM）为10%。5年无复发生存率为69%，5年总生存率为69.5%。我们的预处理方法联合G-BM保留了免疫抑制和清髓作用，能够清除恶性克隆并实现足够的骨髓植入，同时毒性可接受，GVHD发生率低，TRM低，是allo-HSCT的一种有利选择。
