BU＋CY与TBI＋CY两种预处理方案对接受单倍体相合骨髓移植的恶性血液病患者疗效的影响  

Effect of BU and CY versus TBI and CY as conditioning regimens on the efficacy of haploidentical stem cell transplantation in patients with hematologic malignancy

作　　者：邵群[1,2] 韩冬梅[1] 刘丹波[1] 郑晓丽[1] 董磊[1] 王志东[1] 丁丽[1] 闫洪敏[1] 王恒湘[1] 段连宁[1] 

机构地区：[1]解放军空军总医院血液科,北京100142 [2]安徽医科大学北京空军总医院临床学院

出　　处：《中华血液学杂志》2014年第6期505-510,共6页Chinese Journal of Hematology

摘　　要：目的 探讨白消安＋环磷酰胺（BU＋CY）与全身照射（TBI）＋CY两种预处理方案对单倍体相合骨髓移植治疗恶性血液病疗效的影响.方法 回顾性分析2006年1月至2010年12月77例接受单倍体相合骨髓移植治疗的恶性血液病患者临床资料,包括急性髓系白血病21例,急性淋巴细胞白血病33例,慢性髓性白血病19例,骨髓增生异常综合征4例.其中,移植前完全缓解65例,未缓解12例.BU＋CY组39例,BU＋CY组38例.结果 BU＋CY组与TBI＋CY组患者移植后造血重建情况、无病生存及预处理相关死亡情况差异均无统计学意义（P值均＞ 0.05）.BU＋CY与TBI＋CY组患者3年总体生存率分别为56.4％和31.6％（P=0.028 3）.两组累积复发率相似（分别为15.4％和34.2％,P=0.153 8）,而1年内复发率BU＋CY组低于TBI＋CY组（P=0.011 6）.两组Ⅱ～Ⅳ度移植物抗宿主病（GVHD）的发生率分别为20.5％和18.4％（P=0.816 8）,而在可统计范围内慢性GVHD（cGVHD）发生率分别为41.1％和84.6％,TBI＋CY组明显高于BU＋CY组（P=0.000 7）,其中广泛型cGVHD的发生有相似的结果（P=0.041 6）.结论 采用BU＋CY预处理方案移植的患者有较好的3年总体生存率及较低的短期复发率.TBI＋CY方案明显增高cGVHD的发生率而不增加急性GVHD的发生率.半相合移植可选用BU＋CY预处理方案,但应注意防治出血性膀胱炎的发生.Objective To investigate the therapeutic effects of the conditioning regimen with busulfan plus cyclophosphamide （BU＋CY） or total body irradiation plus cyclophosphamide （TBI＋CY） on haploidentical stem cell transplantation （HSCT） in hematologic malignancy.Methods The clinical outcomes of 77 HSCT recipients with hematologic malignancy from January 2001 to December 2010,including 21 AML,33 ALL,19 CML and 4 MDS were retrospectively evaluated.Among them,65 patients obtained complete remission （CR） and 12 non-remission （NR） before transplantation; 39 patients received conditioning regimen with BU＋CY,and 38 with TBI＋CY.Results There were no statistically significant differences in hematopoietic reconstitution,disease free survival （DFS）,and transplant-related mortality （TRM） between two groups.The estimated 3-years overall survival （OS） was 56.4% for BU＋CY and 31.6% for TBI＋CY （P=0.0283）.The overall relapse rate was similar between two groups （15.4% vs 34.2%; P=0.1538）.However,the accumulative probability of relapse at 1-year was significantly lower in BU＋CY than that in TBI＋CY group （2.56% vs 26.67%; P=0.0116）.The incidence of grade Ⅱ-Ⅳ graft-versus-host disease （GVHD） was similar between two regimens （20.5% in BU＋CY group and 18.4% in TBI＋CY group; P=0.8168）.The incidence of chronic GVHD （cGVHD） was higher in the TBI＋CY group than that of BU＋CY group （84.6% vs 41.1%; P=0.0007）.The extensive GVHD obtained the similar outcome （30.8% vs 10.5%; P=0.0416）.Conclusion Patients using BU＋CY as conditioning regimen before transplant could obtain a better 3 year OS and lower short-term relapse rate.The TBI ＋ CY conditioning regimen could significantly increase the incidence of cGVHD without increasing the acute GVHD.BU＋CY conditioning regimen could be used for HSCT,but the attention should be paid to prevent the related hemorrhagic cystitis.

关 键 词：造血干细胞移植 恶性血液病 全身照射 白消安 预处理方案 

分 类 号：R733[医药卫生—肿瘤]