减低预处理剂量亲缘单倍体PBSCT治疗恶性血液肿瘤的临床研究  

Clinical research of related HLA-haploidentical peripheral hematopoietic stem cell transplantation following reduced intensity conditioning regimen with hematological malignancies

作　　者：刘颖[1,2] 段显琳 徐建丽[1,2] 袁海龙 曲建华[1,2] 江明 LIU Ying;DUAN XianLin;XU Jianli;YUAN Hailong;QU Jianhua;JIANG Ming(Hematologic Disease Center,First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830054,Chin;Xinjiang Uygur Autonomous Region Research Institute of Hematology,Urumqi,Xinjiang 830054,China)

机构地区：[1]新疆医科大学第一附属医院血液病中心,乌鲁木齐830054 [2]新疆维吾尔自治区血液病研究所,乌鲁木齐830054

出　　处：《新疆医学》2018年第6期575-578,592,共5页Xinjiang Medical Journal

基　　金：新疆维吾尔自治区高技术研究发展项目(201317104)

摘　　要：目的减低预处理剂量亲缘间HLA单倍体相合外周血造血干细胞移植(RIC-haplo-PBSCT)治疗年轻体弱或高龄恶性血液肿瘤患者的疗效分析。方法根据入排标准纳入2013年7月-2016年11月在本中心治疗的12例恶性血液肿瘤患者,所有患者均采用以FAB+ATG(氟达拉滨+阿糖胞苷+马利兰+抗胸腺球蛋白)的减低剂量的预处理方案,输注供者高剂量不去T细胞PBSC,采用加强的移植物抗宿主病(GVHD)的预防方案及感染防控方案。结果所有患者均获得造血快速重建;10例患者在移植后15天获得完全供者嵌合,2例患者为混合嵌合并于移植后1月出现移植排斥。中位随访23.5月(3~53)月,1年总生存率(OS)为75%,1年无病生存率(DFS)为66.7%,1年复发率(RI)为18.5%,1年非复发死亡率(NRM)为18.1%。结论笔者独特的RIC-haplo-PBSCT方案获得较好的造血恢复、供体植入及生存,为高龄或年轻体弱难以耐受经典清髓移植且找不到HLA全相合供者的恶性血液肿瘤患者提供了更多的治疗机会。Objective To evaluate the efficacy of related HLA-haploidentical peripheral hematopoietic stem cell transplantation following reduced intensity conditioning（RIC）regimen to treat the patients with hematological malignancies who were elder or with pre-existing comorbidities. Methods 12 Patients with hematological malignancies were enrolled from July 2013 to December 2016 treated in our Center. All patients received the RIC regimen consisting of fludarabine, cytarabine, Melphalan, and plus rabbit anti-human thymocyte globulin（ATG）, transplanted with non T cell-depleted in vitro high dose peripheral hematopoietic stem cell.Graft versus host disease（GVHD）prophylaxis and infection prevention were intensively. Results Engraftment was observed in all patients（100%）.Fifteen days after transplantation, 10 patients had complete donor chimerism and 2 patienets had mixed chimerism who converted to complete recipient chimerism at thirty days after transplantation. Patients were followed-up for a median of 23.5 months（range, 3-53 months）. The Kaplan Meier estimates of one-year overall survival and disease free survival were 75% and 66.7%. The one-year cumulative incidence of relapse and non-relapse mortality were 18.5% and 18.1%. Conclusion Our unique transplantation pattern results in sustained engraftment and improved survival, which providing a new feasible curative therapy for those elder or with pre-existing comorbidities patients who are not suitable for myeloablative conditioning regimen, and do not have HLA-matched donor.

关 键 词：减低预处理剂量 亲缘单倍体 外周血造血干细胞移植 

分 类 号：R73[医药卫生—肿瘤]