异基因造血干细胞移植治疗高龄髓系肿瘤30例临床分析  

Treatment of 30 elderly patients with advanced myeloid neoplasm by allogeneic hematopoietic stem cell transplantation

作　　者：杨隽 蔡宇 姜杰玲[1] 万理萍[1] 白海涛 朱骏[1] 李肃[1] 宋献民 王椿[1] Yang Juan;Cai Yu;Jiang Jieling;Wan Liping;Bai Haitao;Zhu Jun;Li Su;Song Xianmin;Wang Chun(Department of Hematology,Shanghai Jiaotong University Affiliated Shanghai General Hospital,Shanghai 200080,Chin)

机构地区：[1]上海交通大学附属上海市第一人民医院血液科,200080

出　　处：《中华血液学杂志》2018年第8期629-633,共5页Chinese Journal of Hematology

摘　　要：目的评估异基因造血干细胞移植（allo-HSCT）治疗高龄髓系肿瘤的疗效。 方法回顾性分析2014年9月至2017年9月接受allo-HSCT的30例髓系肿瘤患者的临床资料，男16例、女14例，中位年龄58（50~67）岁。急性髓系白血病（AML）18例，慢性粒-单核细胞白血病（CMML）1例，骨髓增生异常综合征（MDS）11例。移植时6例患者完全缓解，其余均为未缓解。亲缘全相合（MRD）12例，非血缘全相合（MUD）6例，单倍型12例。18例患者采用减低剂量预处理方案，12例采用了清髓性预处理方案。 结果5例患者在预处理期死亡，24例患者获得造血重建，中性粒细胞、血小板中位植活时间分别为14（10~18）、15（10~19）d。6例患者发生急性GVHD（均为Ⅱ度），8例（32%）患者发生慢性GVHD（中、重度慢性GVHD各1例）。发生巨细胞病毒血症7例，肺部感染7例，皮肤带状疱疹5例，治疗后好转，未出现因感染而死亡的患者。中位随访7（0.5~38）个月，存活21例，预计2年总生存（OS）率为62.5%（95%CI 39.2%~85.8%），无白血病生存率为59.2%（95%CI 26.9%~91.5%）。单因素分析显示，移植时的合并症指数是影响OS的唯一因素。 结论allo-HSCT是高龄髓系肿瘤患者比较理想的治疗选择。ObjectiveTo evaluate the efficacy of allogeneic hematopoietic stem cell transplantation （allo-HSCT） for elderly patients with advanced myeloid neoplasm. MethodsFrom September 2014 to September 2017, 30 consecutive hospitalized 50-plus-year-old myeloid neoplasm patients were retrospectively analyzed. At the time of transplantation, 6 patients reached complete remission and the others remained no remission after treatment. The donors were identical sibling （12）, matched unrelated （6） and haploidentical family member （12）, respectively. 18 patients received RIC while 12 patients received MAC conditioning regiments consisted of Busulfan, cytarabine, fludarabine or clarithromycin±TBI, respectively. ResultsFive patients died early in the conditioning stage, 24 patients successfully engrafted. The median time of neutrophil engraftment was 14（10-18） d, whereas platelet engraftment was 15（10-19） d. Six cases （25%） experienced aGVHD grades Ⅱ, 8 cases （32%） cGVHD, including moderate to severe cGVHD in 2 cases （8%）. Seven, 7 and 5 cases developed CMV viremia, pneumonia and herpeszoster, respectively after transplantation, but no patients died of infections. The median follow-up time of the patients was 7（0.5-38） months. Twenty-one patients were still alive. The estimated 2 years OS and LFS were 62.5% （95% CI 39.2%-85.8%） and 59.2% （95% CI 26.9%-91.5%）, respectively. Univariate analysis showed that HCT-CI was the only factor influencing OS. ConclusionAllogeneic hematopoietic stem cell transplantation could improve the survival of elderly patients with myeloid neoplasm.

关 键 词：造血干细胞移植 血液肿瘤 治疗结果 

分 类 号：R733[医药卫生—肿瘤]