减低强度预处理的异基因造血干细胞移植治疗复发ETO阳性急性髓系白血病的临床研究

本研究旨在探讨减低强度预处理的异基因造血干细胞移植（allo-HSCT）治疗复发ETO阳性急性髓系白血病（AML）的疗效和安全性.采用减低强度预处理的allo-HSCT治疗2010年1月至2013年1月在北京军区总医院收治的15例复发ETO阳性急性髓系白血病患者,全部为复发或难治性高危类型,其中男10例,女5例,年龄16-48岁,平均年龄32.5岁;移植前6例为缓解状态,9例为未缓解状态,10例为HLA配型全相合,5例为HLA配型半相合.全部病例均采用外周血干细胞移植,供者接受粒细胞集落刺激因子动员.预处理方案为降低预处理强度的氟达拉滨联合白舒非、阿糖胞苷及环磷酰胺.移植物抗宿主病（GVHD）预防采用免疫抑制剂,包括环孢素A、氨甲蝶呤、他克莫司等,移植后3个月进行预防性供者外周血干细胞输注,观察全部患者毒副反应、GVHD和无病生存等情况.结果表明：全部患者均获造血重建,中性粒细胞≥0.5×109/L及血小板≥20×109/L的平均时间分别为15.5 d及16.8 d,植入证据检测证实为100％为完全供者造血.随访至2014年6月,中位随访27.5个月（18-54个月）;全部病例中发生GVHD8例,因并发症死亡1例,复发死亡4例,其余10例患者仍无病存活,2年的无病生存率为66.7％,最长无病生存时间已达54个月.结论：减低强度预处理的allo-HSCT挽救性治疗复发ETO阳性急性髓系白血病具有良好疗效,安全系数大,可作为关键技术在临床广泛开展.

Clinical Analysis of Reduced Conditioning Intensity Allo-HSCT Trentment for Relapsed ETO-positive AML

This study was aimed to explore the effect and feasibility of reduced conditioning intensity allogeneic hematopoietic stem cell transplantation （allo-HSCT） in the treatment of relapsed ETO positive acute myeloid leukemia （AML） patients.Fifteen cases of relapsed AML received the reducing conditioning intensity allo-HSCT from January 2011 to January 2013 in Beijing Military Command General Hospital.All patients were high-risk type of relapsed or refractory AML,including 10 males and 5 females,aged from 16 to 48 years old with mean age of 32.5 years.Ten cases are HLA-identical matching and other 5 cases are HLA-haploidentical.donors received granulocyte colonystimulating factor （G-CSF） to mobilize the peripheral blood stem cell for transplantation.Conditioning regimen was fludarabine combined with busulfex,cytarabine and cyclophosphamide.The preventive donor＇s peripheral blood stem cell infusion were performed after 3 months of transplantation,and the toxicity,GVHD and disease-free survival were observed in patients after transplantation.The results showed that all patients achieved hematopoietic reconstitution,the average time of neutrophils ≥0.5 × 109/L and platelets ≥20 × 109/L were 15.5 d and 16.8 d respectively.Implantation was confirmed by the evidence of 100% donor hematopoiesis.Follow-up to June 2014,with a median follow-up duration of 27.5 months （18-54 months）,GVHD occurred in 8 cases of all patients,one died of complication,the other 4 cases died of relapse and the other three patients remained in disease-free survival.The disease-free survival rate of 2-year was 66.7%,the longest disease-free survival time was up to 54 months.It is concluded that the reduced conditioning intensity allo-HSCT is the effective and safe method for relapsed AML with ETO-positive,and it may be chosen as a treatment method for relapsed ETO positive AML patients.