氟达拉滨替代环磷酰胺的预处理方案用于单倍型造血干细胞移植

目的 探讨含氟达拉滨的预处理方案对单倍型造血干细胞移植(HSCT)治疗的可行性和安全性.方法 对35例恶性血液病患者进行单倍型HSCT,其中标危4例,高危16例,复发未缓解15例,所有患者改良预处理用氟达拉滨取代静脉环磷酰胺,氟达拉滨用量为40 mg·m-2·d-1,连用5 d,供者接受rhG-CSF后采集造血干细胞,1例外周血HSCT,1例骨髓移植,33例骨髓加外周血造血干细胞联合移植,移植后观察预处理方案相关不良反应、植入、移植物抗宿主病(GVHD)发生和无病生存状况.结果 所有患者均植入成功,34例患者第1次取得持久植入;1例患者排斥母亲植入物后再进行父亲供髓移植后取得持久植入.所有患者均能较好耐受该预处理方案,无一例因预处理相关不良反应而早期死亡,无肝静脉闭塞病发生.Ⅲ～Ⅳ度急性GVHD 4例,Ⅲ度以上急性GVHD累计发生率为12.1%,慢性GVHD累汁发生率为31.7%.随访时间为8～25个月,死亡6例,复发死亡3例,而非疾病复发死亡3例,其中急性GVHD死亡例,真菌感染死亡1例,其余29例患者仍无病存活,Kaplan-Meier分析无病生存率达79.7%.结论 单倍型移植预处理用氟达拉滨取代静脉环磷酰胺安全可行,降低了方案相关不良反应,且未增加复发和感染率,有利于减少严重急性GVHD、提高移植成功率.

Conditioning regimen containing fludarabine instead of cyclophosphamide for haploidentical hematopoietic stem cell transplantation

Objective To explore the feasibility and safety of conditioning regimen containing fludarabine (Flud) for haploidentieal hematopoietic stem cell transplantation (HSCT).Methods Preparative regimen containing Flud 40 mg·m-2·d-1 on day-7 to-3 in place of eyelophosphamide(CTX) for haploidentical HSCT was given to 35 patients with hematologic malignancies (4 standard risk,16 high risk,15 relapse with no remission).All donors received rhG-CSF followed by HSC harvest.One patient received peripheral blood HSCT(PBSCT),one bone marrow transplantation(BMT),and the others BM combination with PBSCT.The regimen-associated side effect,engraftment,incidence of graft-versus-host disease (GVHD) and disease-free survival(DFS) probabilities were observed.Results All patients achieved sustained,full donortype engraftment.Thirty-four patients obtained primary durable engraftment,and i who rejected graft from his mother obtained successful durable engraftment after the second graft from his father.The cumulative incidence of grade Ⅲ-Ⅳ acute GVHD and chronic GVHD was 12.1% and 31.7%,respectively.With a follow-up duration of 8-25 months,6 patients were dead,in which 3 died of relapse,2 of acute GVHD,1 of fungal infection,none died of regimen-associated side effect.The other 29 patients remained alive and DFS probability was 79.7%.Conclusion Flud based conditioning regimens for haploidentical HSCT is safe and feasible,which reduces regimen-associated side effect,with no increasing the rate of relapse and infection,and decreases the incidence of aGVHD.