Zhao X L, Jiang E L, Zhai W H, Ma Q L, Pang A M, Wei J L, He Y, Yang D L, Feng S Z, Han M Z
Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
Zhonghua Xue Ye Xue Za Zhi. 2019 Jun 14;40(6):467-471. doi: 10.3760/cma.j.issn.0253-2727.2019.06.004.
To assess the efficacy and toxicity of decitabine-based conditioning regimen in patients with myelodysplastic syndrome (MDS) , acute myeloid leukemia secondary to MDS (MDS-AML) or chronic myelomonocytic leukemia (CMML) . From March 1, 2013 to May 25, 2015, 22 patients who underwent allogenic hematopoietic stem cell transplantation (allo-HSCT) with decitabine-based conditioning regimen were analyzed retrospectively. ①22 patients, 14 males and 8 females with a median age of 42.5 (24-56) years old, were diagnosed as MDS (=14) , CMML (=4) , MDS-AML (=4) . ②15 patients were treated with the conditioning regimen of decitabine combined with busulfan, cyclophosphamide, fludarabine, and cytarabine, the other 7 cases were treated with decitabine, busulfan, fludarabine, and cytarabine. The dose of decitabine was 20 mg·m(-2)·d(-1) for 5 days.Rabbit anti-human anti-thymocyte globulin (2.5 mg·kg(-1)·d(-1) for 4 days) was involved in conditioning regimen in patients with unrelated donor or haploidentical transplantation. ③Except 1 patient died of infection in 2 months after transplantation, the other patients were engrafted successfully. The median time of granulocyte engraftment was 13 (12-18) days, and the median time of platelet engraftment was 16 (13-81) days. ④The incidence of acute graft versus host disease (aGVHD) was (41.3±10.6) %, and severe aGVHD (grade of III-IV) was (18.4±9.7) %. The incidence of chronic graft versus host disease (cGVHD) was (56.4±11.3) %, and extensive cGVHD was (36.4±12.1) %. ⑤8 patients were suffered with cytomegalovirus (CMV) viremia. Among the 18 patients with definitely infection, 6 occurred during myelosuppression and 12 cases occurred after hematopoietic reconstruction. The 2-year and 3-year non-relapse mortality was (13.9±7.4) % and (24.3±9.5) %, respectively. ⑥The 2-year and 3-year overall survival (OS) was (77.3±8.9) % and (67.9±10.0) %, respectively. The 2-year and 3-year relapse-free survival (RFS) was (72.7±9.5) % and (63.6±10.3) %, respectively. allo-HSCT with decitabine-based conditioning regimen is feasible in the treatment of MDS, MDS-AML or CMML.
评估基于地西他滨的预处理方案治疗骨髓增生异常综合征（MDS）、MDS继发的急性髓系白血病（MDS-AML）或慢性粒-单核细胞白血病（CMML）患者的疗效及毒性。回顾性分析2013年3月1日至2015年5月25日期间22例行基于地西他滨预处理方案的异基因造血干细胞移植（allo-HSCT）的患者。①22例患者，男性14例，女性8例，中位年龄42.5（24 - 56）岁，诊断为MDS（=14例）、CMML（=4例）、MDS-AML（=4例）。②15例患者接受地西他滨联合白消安、环磷酰胺、氟达拉滨及阿糖胞苷的预处理方案，另外7例接受地西他滨、白消安、氟达拉滨及阿糖胞苷治疗。地西他滨剂量为20mg·m⁻²·d⁻¹，共5天。无关供者或单倍体相合移植患者的预处理方案中加入兔抗人抗胸腺细胞球蛋白（2.5mg·kg⁻¹·d⁻¹，共4天）。③除1例患者移植后2个月死于感染外，其他患者均成功植入。粒细胞植入中位时间为13（12 - 18）天，血小板植入中位时间为16（13 - 81）天。④急性移植物抗宿主病（aGVHD）发生率为（41.3±10.6）%，重度aGVHD（Ⅲ - Ⅳ级）为（18.4±9.7）%。慢性移植物抗宿主病（cGVHD）发生率为（56.4±11.3）%，广泛性cGVHD为（36.4±12.1）%。⑤8例患者发生巨细胞病毒（CMV）血症。在18例明确感染的患者中，6例发生于骨髓抑制期，12例发生于造血重建后。2年和3年非复发死亡率分别为（13.9±7.4）%和（24.3±9.5）%。⑥2年和3年总生存率（OS）分别为（77.3±8.9）%和（67.9±10.0）%。2年和3年无复发生存率（RFS）分别为（72.7±9.5）%和（63.6±10.3）%。基于地西他滨预处理方案的allo-HSCT治疗MDS、MDS-AML或CMML是可行的。
