氟达拉滨联合马利兰的减低剂量预处理治疗恶性血液病

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。

Fludarabine and busulfan as a reduced intensity myeloablative conditioning regimen for allogeneic stem cell transplantation in hematologic malignancies

Objective To analyze the safety and efficacy of fludarabine and busulfan(FB) as a reduced intensity myeloablative conditioning regimen for allogeneic stem cell transplantation in elderly or other hematologic malignancies patients who were not well tolerance to standard myeloablative conditioning regimen.Methods Data of 14 patients who underwent allogeneic stem cell transplantation with FB conditioning regimen from August of 2009 in the Hematology Department of PLA General Hospital were retrospectively studied.Results Fourteen patients,12 older than 50 years old and 3 patients ever received transplantation with myeloablative conditioning regimen,tolerated the allogeneic stem cell transplantation with FB conditioning regimen well.Patients achieved myeloid and platelet engraftment at a median of 13(10-16) days and 17(13-28) days,respectively.All patients achieved full donor chimerism at 28 days after transplantation.After a 9.5(3-22.5) months follow-up,the incidence of acute graft-versus-host disease(GVHD),the chronic GVHD,the relapse and the 2-years overall survival were 35.6%,33.3%,14.3% and(54.4±14)%,respectively.Conclusion Conditioning regimen with FB were safe and efficient for hematologic malignant patients who were not eligible for standard transplantation,but the management of immunosuppression drugs and infection should be taken into consideration.