论文部分内容阅读
目的探讨异基因外周血干细胞移植(allo-PBSCT)早期快速递减免疫抑制剂治疗难治复发白血病的疗效。方法对2004年1月至2006年12月中山大学附属第一医院和中国协和医科大学血液病医院收治的15例难治复发白血病患者实施亲缘allo-PBSCT,其中12例为人类白细胞抗原(HLA)完全相合同胞移植。预处理方案主要包括马利兰+环磷酰胺(BuCy)和全身照射+环磷酰胺(TBICy),部分联合阿糖胞苷。移植物抗宿主病(GVHD)的预防采用环孢素A(CsA)或他克莫司(FK506),对HLA同胞相合移植后30d内仍无GVHD征象的患者于移植后30~90d采用快速递减免疫抑制剂,维持低血药浓度。结果15例患者均获移植后快速造血重建,其中5例患者出现Ⅰ~Ⅱ度急性GVHD,可评价的11例患者发生慢性GVHD7例。采用早期快速递减免疫抑制剂的9例患者中,仅1例发生Ⅰ度急性GVHD,4例发生慢性GVHD,2例髓外复发。至随访截止日,15例患者无白血病存活(LFS)8例,LFS中位时间为328d,复发4例(占27%),移植后前3个月内死亡仅1例(占7%),1年累积LFS率为51%,2年累积LFS为25%。结论难治复发白血病allo-PBSCT治疗显著降低治疗失败率;HLA同胞相合移植早期快速递减免疫抑制剂剂量可能进一步增强移植物抗白血病(GVL)效应,有利于长期无白血病存活。
Objective To investigate the effect of allo-PBSCT early rapid declining immunosuppressive agents in the treatment of refractory relapsed leukemia. Methods Allo-PBSCT was performed on 15 patients with refractory relapsed leukemia admitted to the First Affiliated Hospital of Sun Yat-sen University and the Hematology Hospital of Peking Union Medical College from January 2004 to December 2006, of which 12 were human leukocyte antigen (HLA) Fully compatible with sibling transplant. Pretreatment programs include mainly Marital + cyclophosphamide (BuCy) and systemic irradiation + cyclophosphamide (TBICy), part of the combination of cytarabine. Prevention of graft-versus-host disease (GVHD) With cyclosporin A (CsA) or tacrolimus (FK506), patients with no GVHD within 30 days after transplantation of HLA-matched siblings were treated with rapid reduction Immunosuppressants, to maintain low plasma concentration. Results All of the 15 patients received rapid hematopoietic reconstitution after transplantation. Among them, 5 cases developed grade Ⅰ ~ Ⅱ acute GVHD and 11 cases were evaluated for chronic GVHD. Of the 9 patients who received early rapid immunosuppressive immunosuppressants, only 1 had acute GVHD, 4 had chronic GVHD, and 2 had extramedullary recurrence. By the deadline for follow-up, 8 of 15 patients had no leukemia survival (LFS), the median time to LFS was 328 days, the recurrence occurred in 4 cases (27%), and only 1 patient died in the first 3 months after transplantation (7% The 1-year cumulative LFS rate was 51% and the 2-year cumulative LFS was 25%. Conclusions Allo-PBSCT treatment of refractory relapsed leukemia significantly reduces the failure rate of treatment. The dose of immunosuppressive agents in early stage of HLA sibling transplantation may further enhance the effect of graft anti-leukemia (GVL), which is beneficial to long-term leukemia-free survival.