Zheng Wen-Shuai, Guan Li-Xun, Cheng Long-Can, Xu Yuan-Yuan, Shi Ling-Hao, Sun Ding, Bo Jian, Wang Quan-Shun, Gao Xiao-Ning
Department of Hematology, Hainan Hospital of Chinese PLA General Hospital , Sanya 572000, Hainan Province, China.
Department of Hematology, Chinese PLA General Hospital, Beijing 100853, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2020 Jun;28(3):742-747. doi: 10.19746/j.cnki.issn.1009-2137.2020.03.005.
To analyze the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for treatment of acute leukemia in the tropical area.
Twelve acute leukemia patients who were underwent allo-HSCT from April 2013 to November 2018 in Hainan Hospital of Chinese PLA General Hospital were selected, including 5 cases of acute lymphoblastic leukemia (ALL) and 7 case of acute myeloid leukemia (AML). Three cases received HLA matched sibling hematopoietic stem cell transplantation, 8 cases received haploidentical hematopoietic stem cell transplantation, 1 cases received partially mismatched unrelated hematopoietic stem cell transplantation. Pretreatment regimen: 9 cases received modified BU/CY+ATG pretreatment regimen, 3 cases received BU/CY pretreatment regimen. Graft-versus-host disease (GVHD) prevention regimen: all patients received cyclosporine A, mycophenolate mofetil combined with short-term methotrexate regimen. The clinical efficacy of allo-HSCT in treatment of acute leukemia in the tropical area was analyzed by detecting hematopoietic reconstitution, GVHD, infection, relapse and survival after transplantation.
All the 12 patients achieved granulocyte reconstruction and megakaryocyte reconstruction. The median time of granulocyte reconstruction was 11.5 (6-14) days, and the median time of megakaryocytic reconstruction was 12.5 (10-22) days. Within 100 days after transplantation, the acute GVHD occurved in 8 cases, including 6 cases of Ⅱ-Ⅳ degree acute GVHD and 2 cases of Ⅲ-Ⅳ degree acute GVHD, 11 cases survived more than 100 days after transplantation, and the chronic GVHD occurred in 1 case, which was mildly limited. Pulmonary infection occurred in 7 cases, cytomegaloviremia occurred in 6 cases, EB viremia occurred in 6 cases, and hemorrhagic cystitis occurred in 5 cases. 2 cases relapsed and eventually died, and the remaining 10 patients survived without disease until the date of follow-up. The median follow-up time was 4 (1-68) months, 83.3% (10/12) survived without disease, and 16.7% (2/12) relapsed.
Allo-HSCT is an effective method for the treatment of acute leukemia in adults. Leukemia patients should be transplanted as soon as possible after remission. The incidence of pulmonary fungal infection in transplanted patients in tropics is high, therefore the prevention and treatment of fungal infection should be strengthened.
分析异基因造血干细胞移植（allo-HSCT）治疗热带地区急性白血病的疗效。
选取2013年4月至2018年11月在中国人民解放军总医院海南医院接受allo-HSCT的12例急性白血病患者，其中急性淋巴细胞白血病（ALL）5例，急性髓系白血病（AML）7例。3例接受HLA配型相合的同胞造血干细胞移植，8例接受单倍体造血干细胞移植，1例接受部分错配的非血缘造血干细胞移植。预处理方案：9例接受改良BU/CY+ATG预处理方案，3例接受BU/CY预处理方案。移植物抗宿主病（GVHD）预防方案：所有患者均接受环孢素A、霉酚酸酯联合短期甲氨蝶呤方案。通过检测移植后的造血重建、GVHD、感染、复发及生存情况，分析allo-HSCT治疗热带地区急性白血病的临床疗效。
12例患者均实现粒细胞重建和巨核细胞重建。粒细胞重建的中位时间为11.5（6-14）天，巨核细胞重建的中位时间为12.5（10-22）天。移植后100天内，8例发生急性GVHD，其中Ⅱ-Ⅳ度急性GVHD 6例，Ⅲ-Ⅳ度急性GVHD 2例；11例移植后存活超过100天，1例发生慢性GVHD，为轻度局限性。7例发生肺部感染，6例发生巨细胞病毒血症，6例发生EB病毒血症，5例发生出血性膀胱炎。2例复发并最终死亡，其余10例患者至随访时无病存活。中位随访时间为4（1-68）个月，83.3%（10/12）无病存活，16.7%（2/12）复发。
allo-HSCT是治疗成人急性白血病的有效方法。白血病患者缓解后应尽早进行移植。热带地区移植患者肺部真菌感染发生率高，因此应加强真菌感染的防治。
