标准与强化预处理方案对急性淋巴细胞白血病异基因造血干细胞移植后疗效的比较  

Comparative outcome of allogeneic hematopoietic stem cell transplantation for acute lymphocytic leukemia following standard and sequential intensified conditioning regimens

作　　者：张复华[1] 刘启发[2] 李蕊[1] 凌奕文[1] 杨国雷[1] 牛国敏[1] 徐嘉愉 

机构地区：[1]南方医科大学附属南海医院,528200 [2]南方医科大学附属南方医院

出　　处：《中国现代药物应用》2014年第1期19-21,共3页Chinese Journal of Modern Drug Application

摘　　要：目的对比分析标准与强化预处理方案对急性淋巴细胞白血病(ALL)异基因造血干细胞移植后疗效的影响。方法标准预处理方案包括TBI+CY、改良BuCY和GIAC方案,强化预处理方案包括TBI+CY+VP-16/VM-26和FA+TBI+CY+VP-16方案。中位随访时间为811 d。结果标准组(n=125)与强化组(n=78)移植前疾病状态差异有统计学意义(P<0.01),造血重建时间、GVHD发生率和移植相关毒性差异无统计学意义,标准组复发率及死亡率(33.6%,55.2%)均较强化组(26.9%,48.7%)高,但差异均无统计学意义(P=0.433及P=0.450),其中,CR状态下患者行超强预处理方案移植,其死亡率比标准组明显降低(P=0.017)。两组患者5年总生存率(OS)和无复发生存率(DFS)(44.1±5.6)%、(46.8±7.8)%和(36.5±6.9)%、(44.9±7.5)%,强化组均较标准组高,差异无统计学意义(P=0.831、0.652)。结论强化预处理方案耐受性好,相比标准预处理方案,其OS与DFS均较高。Objective To retrospectively compare the prognosis of allogeneic hematopoietic stem cell transplantation for acute lymphoblastic leukemia following the standard and intensitied conditioning regimens. Methods The standard conditioning regimens included total body irradiation ＋ cyclophosphamide, modified busulfan ＋ cyclophosphamide, and GIAC protocol. The intensitied conditioning regimens included total body irradiation ＋ cyclophosphamide ＋ etoposide or teniposide and fludarabine ＋ cytarabine ＋ irradiation ＋ cy- clophosphamide. The median follow-up time was 811 days. Results The difference of states before transplant between the standard group （ n = 125） and intensitied group （ n = 78 ） was significant （ P 〈 0. 001 ）. The neutrophils and platelets reconstruction time, the incidences of graft versus host disease （ GVHD）, and the inci- dences of regimens related toxicity were all not statistically significant between standard and intensitied group. The relapse and mortality rate in standard group （33.6%, 55.2% ） were higher than that in intensified group （26.9%, 48.7% ）. The difference was not significant （P =0. 433, 0. 450）. In patients with CR, the mortali- ty in standard group was significant higher than that in intensitied group （P =0. 017）. The 5-year overall sur- vival （OS） were （44. 1 ± 5.6）% and （46.8 ±7.8）%, the 5-year disease-free survival （DFS） were （36.5 ± 6. 9） % and （44. 9 ± 7. 5 ） % in standard and intensitied group, respectively. The 5-year OS and DFS in in- tensified group were higher than that in standard group, the difference were both not significant （P =0. 831 and

关 键 词：预处理方案 急性淋巴细胞白血病 异基因造血干细胞移植 

分 类 号：R733.71[医药卫生—肿瘤]