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氟达拉滨、马法兰和阿仑单抗减低强度异基因造血干细胞移植治疗 HIV 感染合并急性髓系白血病患者的移植物抗白血病效应。

Graft-versus-leukaemia effect post fludarabine, melphalan and alemtuzumab reduced intensity allogeneic stem cell transplantat in HIV-infected patient with acute myeloid leukaemia.

机构信息

Haematology and Stem Cell Transplantation Department Heart of England NHS Trust, Birmingham, United Kingdom.

出版信息

Bone Marrow Transplant. 2018 Dec;53(12):1518-1521. doi: 10.1038/s41409-018-0297-z. Epub 2018 Aug 16.

Abstract

Allogeneic stem cell transplantation (Allo-HSCT) is sine qua non to cure high-risk acute myeloid leukaemia (AML). In spite the advent of highly active antiretroviral treatment, HIV-infected patients display a remarkable risk for haematological neoplasms such as non-Hodgkin lymphomas, Hodgkin lymphoma and acute leukaemia. Several case series have confirmed the efficacy of the autologous stem cell transplantation for the treatment of non-Hodgkin lymphomas in the HIV setting. Nonetheless, there is a paucity of data for the role of the Allo-HSCT in HIV-infected individuals with haematological malignancies. Herein, we presented the successful long-term outcome of a HIV-infected patient who received reduced intensity conditioned, matched unrelated donor transplant with alemtuzumab as graft-versus-host disease prophylaxis for therapy-related acute myeloid leukaemia. We propose that Allo-HSCT in HIV patients is safe and that alemtuzumab-based conditioning could further work to eradicate HIV in those whose donor is not CCR5 homozygous.

摘要

异基因造血干细胞移植(Allo-HSCT)是治愈高危急性髓系白血病(AML)的必要手段。尽管有高效抗逆转录病毒治疗(highly active antiretroviral treatment),HIV 感染患者仍然存在显著的血液系统恶性肿瘤风险,如非霍奇金淋巴瘤、霍奇金淋巴瘤和急性白血病。有几项病例系列研究证实了自体造血干细胞移植在 HIV 背景下治疗非霍奇金淋巴瘤的疗效。然而,对于 Allo-HSCT 在 HIV 感染者血液系统恶性肿瘤中的作用,数据仍然有限。在此,我们报告了一名 HIV 感染患者接受减低强度预处理、匹配无关供体移植并使用阿仑单抗作为移植物抗宿主病预防治疗相关性急性髓系白血病的成功长期结果。我们提出,HIV 患者的 Allo-HSCT 是安全的,并且基于阿仑单抗的预处理可能有助于消除那些供体不是 CCR5 纯合子的 HIV。

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