外周血干细胞移植联合早期快速递减免疫抑制剂治疗难治复发白血病15例临床研究  

Faster reduction of the immunosuppressive drug dosage in early stage of allogeneic peripheral blood stem cell transplantation for patients with refractory or relapsed leukemia.

作　　者：王荷花[1] 李娟[1] 黄勇[2] 韩明哲[2] 

机构地区：[1]中山大学附属第一医院血液内科,广州510080 [2]中国协和医科大学血液病研究所、血液病医院,天津300020

出　　处：《中国实用内科杂志》2008年第5期352-354,共3页Chinese Journal of Practical Internal Medicine

摘　　要：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l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5l％，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 early reduction of the dose of immunosuppressive drug after allogeneic peripheral blood stem cell transplantation （allo-PBSCT） for patients with refractory or relapsed leukemia. Methods Between Janaury 2004 and December 2006,15 patients with relapsed or refractory leukemia in Department of Hematology, the First Affiliated Hospital, Sun Yat-Sen University and Institute of Hematology ＆ Blood Diseases Hospital, CAMS ＆ PUMC, received allo-PBSCT from their relatives, 12 from HLA-identical siblings. The preparative regimens included BuCy and TBICy with or without cytarabine. Cyclosporine A（ CsA ） or tacrolimus was used for graft-versus-host disease （ GVHD ） prophylaxis, with rapid decreasing starting on day 30 of post transplant if no GVHD appeared in receipts of matched sibling tranplantation. Results （ 1 ） Faster engraftment was achieved in all patients. Grade Ⅰ - Ⅱ acute GVHD appeared in 5 patients. Chronic GVHD occured in 7 of 11 evaluable patients. （2）Of 9 patients with an lower CsA or tacrolimus dosage, only 1 developed grade Ⅰ acute GVHD,4 chronic GVHD,2 extramedullary relapse. （3）After a median follow-up of 328 days,8 patients has leukemia-free-survival（LFS） ,4 relapsed, and only 1 had transplantation-related mortality （TRM）in the first 3 months post-transplant. The estimated LFS at 1 year and 2 years was 51% and 25 %, respectively. Conclusion Patients with advanced leukemia might benefit from allo-PBSCT with significant lower treatment failure incidence. Dose reductions of CsA and tacrolimus in early transplant might enhance graft-versus-leukemia effect, and improve long-term LFS.

关 键 词：干细胞移植 异基因 外周血 白血病 

分 类 号：R5[医药卫生—内科学]