地西他滨桥接异基因造血干细胞移植治疗骨髓增生异常综合征和急性髓样白血病的临床可行性和疗效研究  

Clinical observation of feasibility and efficacy of decitabine bridge therapy followed by allogeneic hematopoietic stem cell transplantation in patients with myelodysplastic syndrome and acute myeloid leukemia

作　　者：吴倩[1] 何广胜[1] 吴德沛[1] 孙爱宁[1] 仇惠英[1] 金正明[1] 苗瞄[1] 唐晓文[1] 韩悦[1] 沈益民[1] 陈峰[1] 胡晓慧[1] 金松[1] 张旭辉[1] 

机构地区：[1]苏州大学附属第一医院血液科,江苏省血液病研究所,卫生部血栓与止血重点实验室,江苏苏州215006

出　　处：《肿瘤》2013年第3期264-270,共7页Tumor

基　　金：国家科技支撑计划资助项目(编号:2008BAI61B02);卫生公益性行业科研专项经费资助项目(编号:201202017);江苏省医学重点人才资助项目(编号:H201126);江苏高校优势学科建设工程一期资助项目;江苏省临床医学中心(高技术平台)建设资助项目(编号:ZX201102);江苏省高校自然科学研究项目(编号:09KJB320015)

摘　　要：目的:探讨地西他滨(decitabine,DAC)作为骨髓增生异常综合征(myelodysplastic syndrome,MDS)和急性髓样白血病(acute myeloid leukemia,AML)患者行异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)之前的桥接治疗的可行性和疗效。方法:对7例MDS患者和12例AML患者以DAC作为allo-HSCT之前的桥接治疗。结果:DAC桥接治疗后,7例MDS患者中,4例获得完全缓解(complete remission,CR)/mCR(marrow CR),3例为疾病稳定(stable disease,SD),之后行allo-HSCT成功,目前6例为无病生存,1例在复发后接受供者淋巴细胞输注(donor lymphocyte infusion,DLI)后达CR,后死于肺部感染;12例AML患者中,6例在DAC桥接治疗后获得CR,目前5例为无病生存,6例死亡,1例为带瘤生存。急性和慢性GVHD发生率分别为31.6%和21.1%。DAC桥接治疗后2年总生存率为56.7%,allo-HSCT后2年总生存率和2年累积复发率分别为57.9%和36.2%,allo-HSCT后2年累积非复发死亡率为23.6%。结论:DAC可安全有效地桥接allo-HSCT以治疗MDS和AML患者。Objective： To investigate the feasibility and efficacy of DAC （decitabine） bridge therapy followed by alIo-HSCT （allogeneic hematopoietic stem cell transplantation） in patients with MDS （myelodysplastic syndrome） and AML （acute myeloid leukemia）. Methods： Seven patients with MDS and 1 2 patients with AML received DAC bridge therapy followed by alIo-HSCT. Results： With DAC bridge therapy,4 MDS patients achieved complete remission/marrow complete remission and 3 remained stable disease before alIo-HSCT. After successful engraftment attained in all the seven MDS patients, six survived without disease, one received donor lymphocyte infusion and obtained complete remission after relapse and eventually died of pneumonia. Of 12 AML patients, 6 achieved complete remission after DAC bridge therapy; 5 survived without disease, one still survived but having disease, and 6 had died. The rates of acute and chronic GVHD were 31.6% and 21.1%, respectively. The two-year overall survival rate and the two-year cumulative recurrence rate were 57.9% and 36.2% after alIo-HSCT, respectively. The two-year cumulative recurrence-free rate was 23.6% after alIo-HSCT. Conclusion： DAC regimen can be safely and efficiently administrated to bridge time to alIo-HSCT in patients with MDS/AML.

关 键 词：骨髓增生异常综合征 白血病 髓样 急性 地西他滨 造血干细胞移植 桥接治疗 

分 类 号：R733.7[医药卫生—肿瘤]