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目的分析氟达拉滨联合马利兰(FB)预处理进行异基因造血干细胞移植治疗高龄或耐受性欠佳患者的安全性和疗效。方法回顾性分析我科开展的14例FB方案减低剂量预处理的异基因造血干细胞移植患者资料,详细研究FB方案的不良反应、造血重建情况、移植物抗宿主病(GVHD)发生情况和生存状况。结果 14例中8例为疾病进展状态,12例年龄>50岁,3例曾接受过经典的清髓性造血干细胞移植,均能很好地耐受FB方案预处理异基因造血干细胞移植。移植后粒系造血重建中位时间13(10-16)d;血小板重建中位时间17(13-28)d。所有患者移植后28d骨髓均为完全供者型嵌合。随访9.5(3-22.5)月,42.9%患者在移植后6月内确诊感染,急性GVHD发生率35.6%,慢性GVHD发生率33.3%,复发率14.3%,2年总生存率(54.4±14)%。结论对高龄或耐受性不佳的患者,减低剂量FB预处理方案安全、有效,但需注意感染的防治和免疫抑制剂的调整。
Objective To analyze the safety and efficacy of fludarabine combined with pre-treatment with mariland (FB) for allogeneic hematopoietic stem cell transplantation in elderly patients with poor tolerability. Methods Retrospective analysis of 14 cases of FB program in our department to reduce the dosage of pretreatment of allogeneic hematopoietic stem cell transplantation patient data, a detailed study of FB regimen adverse reactions, hematopoietic reconstitution, graft-versus-host disease (GVHD) and survival status . Results Of the 14 cases, 8 cases were disease progression, 12 cases were over 50 years old and 3 cases had received classic myeloablative stem cell transplantation. All of them were well tolerated by FB pretreatment for allogeneic hematopoietic stem cell transplantation. After transplanting, the median time for hematopoietic reconstitution was 13 (10-16) d, and the median time for platelet reconstruction was 17 (13-28) d. All patients received complete donor-type chimerism 28 days after transplantation. Follow-up 9.5 (3-22.5) months, 42.9% of the patients were diagnosed within 6 months after transplantation. The incidence of acute GVHD was 35.6%, the incidence of chronic GVHD was 33.3%, the recurrence rate was 14.3% and the 2-year overall survival rate was 54.4 ± 14 %. Conclusions For elderly patients or poor tolerant patients, it is safe and effective to reduce the dose of FB pretreatment regimen, but pay attention to the prevention of infection and the adjustment of immunosuppressive agents.