含TMLI的移植前预处理在复发难治白血病中的应用  

The TMLI/IDA/CY conditioning for relapsed/refractory acute leukemia undergoing allogeneic hematopoietic stem cell transplantation

作　　者：赵晓艳 师柳 周茜[1] 陆铉 严晗 石威 仲照东 游泳[1] 熊玉 邓涤[2] 夏凌辉[1] 胡豫[1] 王华芳[1] ZHAO Xiaoyan;SHI Liu;ZHOU Xi;LU Xuan;YAN Han;SHI Wei;ZHONG Zhaodong;YOU Yong;XIONG Yu;DENG Di;XIA Linghui;HU Yu;WANG Huafang(Department of Hematology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,China;Department of Radiation and Medical Oncology,Zhongnan Hospital of Wuhan University)

机构地区：[1]华中科技大学同济医学院附属协和医院血液病研究所,武汉430022 [2]武汉大学中南医院放化疗科

出　　处：《临床血液学杂志》2020年第4期475-480,共6页Journal of Clinical Hematology

基　　金：国家自然科学基金(No:81770134)。

摘　　要：目的:异基因造血干细胞移植(allo-HSCT)是治疗难治复发急性白血病的一种有效方法,预处理方案是影响患者生存的重要因素之一,以全身照射(TBI)或全骨髓联合全淋巴照射(TMLI)为基础的预处理方案被应用于接受allo-HSCT的复发难治白血病患者中。然而,由于TBI可导致短期或长期毒性,TBI正逐渐被新发展的TMLI所取代。本研究旨在探讨以TMLI-IDA-CY为预处理的造血干细胞移植对复发难治急性白血病患者的疗效。方法:回顾性评估22例接受以TMLI-IDA-CY为预处理的allo-HSCT的复发难治白血病患者的临床结果。结果:在22例患者中,观察到Ⅰ级恶心或呕吐8例,Ⅰ~Ⅱ级腹泻9例,Ⅰ~Ⅱ级口咽黏膜炎8例。所有患者均未发生Ⅲ~Ⅳ级非血液学不良反应。复发难治急性白血病患者的生存结果是可以接受的(2年总生存率49.3%,累积复发率47.2%,无病生存率47.8%,移植相关死亡率9.1%)。+100 d、+365 d完全缓解率分别为77.3%和53.7%。结论:在接受allo-HSCT的复发难治急性白血病患者中使用TMLI这种新放疗手段是安全有效的。Objective:The outcomes of relapsed/refractory acute leukemia(RRAL) underwent allogeneic hematopoietic stem cell transplantation(allo-HSCT) are still very poor,in which conditioning regimen is one of the important factors affecting the survival of patients.Myeloablative conditioning regimens on the basis of total body irradiation(TBI)/total morrow lymphoid irradiation(TMLI) were currently used in allo-HCST for patients with RRAL.Nevertheless,due to the toxicities of TBI,TBI has been gradually replaced by novel TMLI.The purpose of this study was to investigate the efficacy of hematopoietic stem cell transplantation pretreated with TMLI-IDA-CY in patients with RRAL.Method:The current study retrospectively assessed the outcomes of 22 patients with RRAL underwent allo-HSCT receiving TMLI-containing conditioning.The TMLI-based conditioning regimen included TMLI,idarubicin and cyclophosphamide.Result:Eight cases(36.36%),9 cases(40.91%),8 cases(36.36%) suffered from grade Ⅰ nausea or vomiting,grade Ⅰ-Ⅱ diarrhea and grade Ⅰ-Ⅱ oropharyngeal mucositis,respectively.None of patients developed grade Ⅲ-Ⅳ non-hematologic adverse events.The estimated two-year survival outcomes of novel TMLI-containing conditioning were acceptable in our study(transplant-related mortality was 9.1%;overall survival was 49.3%;disease-free-survival was 47.8%;cumulative incidence of recurrence was 47.2%).The complete remission rates of +100,+365 days were 77.3% and 53.7%,respectively.Conclusion:Conditioning with novel TMLI is safe and effective in patients with RRAL who received allo-HSCT.

关 键 词：全骨髓联合全淋巴照射 急性白血病 异基因造血干细胞移植 复发难治 

分 类 号：R733.71[医药卫生—肿瘤]