高剂量非体外去T细胞PBSC作为移植物行减低剂量预处理单倍体HSCT治疗老年急性髓系白血病及骨髓增生异常综合征患者效果观察  

Efficacy observation of high-dose non-T-cell depleted PBSC used as grafts for haploidentical HSCT with reduced intensity conditioning in elderly patients with AML/MDS

作　　者：苗文艳 徐建丽[1] 袁海龙[1] 王洪波[1] 刘颖[1] 韩春霞[1] 丁凌陆[1] 江明[1] Miao Wenyan;Xu Jianli;Yuan Hailong;Wang Hongbo;Liu Ying;Han Chunxia;Ding Linglu;Jiang Ming(Hematologic Disease Center,the First Affiliated Hospital of Xinjiang Medical University,Xinjiang Uygur Autonomous Region Research Institute of Hematology,Urumqi 830054,China)

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

出　　处：《白血病．淋巴瘤》2023年第11期652-657,共6页Journal of Leukemia & Lymphoma

基　　金：国家自然科学基金(81660032);国家血液系统疾病临床医学研究中心转化研究课题(2021WWC03);新疆维吾尔自治区研究生科研创新项目(XJ2022G155)。

摘　　要：目的探讨高剂量非体外去T细胞外周血造血干细胞(PBSC)作为移植物行减低剂量预处理单倍体造血干细胞移植(RIC-haplo-HSCT)治疗老年急性髓系白血病(AML)及骨髓增生异常综合征(MDS)患者的临床效果。方法回顾性分析2014年1月至2022年6月新疆医科大学第一附属医院收治的28例行RIC-haplo-HSCT治疗的年龄≥50岁AML及MDS患者的临床资料。所有患者均采用高剂量非体外去T细胞PBSC作为移植物,加用抗CD25单克隆抗体和糖皮质激素作为强化移植物抗宿主病(GVHD)预防方案。结果28例患者均获得造血重建。100 d内Ⅱ~Ⅳ度、Ⅲ~Ⅳ度急性GVHD的累积发生率分别为22.5%(95%CI 5.1%~39.9%)和8.2%(95%CI 0~19.2%)。3年慢性GVHD的累积发生率为26.8%(95%CI 7.8%~45.8%),广泛型慢性GVHD的累积发生率为5.9%(95%CI 0~17.1%)。中位随访35.5个月(2~83个月),3年累积复发率和非复发死亡率分别为16.7%(95%CI 2.0%~31.9%)、12.2%(95%CI 0~25.2%)。3年无病生存率和总生存率分别为73.3%(95%CI 56.2%~90.4%)、79.1%(95%CI 62.2%~96.0%)。结论高剂量非体外去T细胞PBSC作为移植物行RIC-haplo-HSCT治疗老年AML及MDS患者的临床效果较好。Objective To investigate the clinical efficacy of high-dose non-T-cell depleted peripheral blood stem cells(PBSC)used as grafts in haploidentical hematopoietic stem cell transplantation with reduced intensity conditioning(RIC-haplo-HSCT)in the treatment of elderly patients with acute myeloid leukemia(AML)or myelodysplastic syndrome(MDS).Methods The clinical data of AML or MDS 28 patients aged≥50 years who underwent RIC-haplo-HSCT in the First Affiliated Hospital of Xinjiang Medical University from January 2014 to June 2022 were retrospectively analyzed.All patients received high-dose non-T-cell depleted PBSC as grafts.Anti-CD25 monoclonal antibody and glucocorticoid were added as intensive graft-versus-host disease(GVHD)prophylaxis.Results All patients achieved hematopoietic reconstruction.The accumulative incidence of gradeⅡ-ⅣandⅢ-Ⅳacute GVHD within 100 d was 22.5%(95%CI 5.1%-39.9%)and 8.2%(95%CI 0-19.2%),respectively.The 3-year cumulative incidence of chronic GVHD was 26.8%(95%CI 7.8%-45.8%),and the incidence of extensive chronic GVHD was 5.9%(95%CI 0-17.1%).The median follow-up time was 35.5(2-83)months.The 3-year cumulative incidence of relapse and non-relapse mortality was 16.7%(95%CI 2.0%-31.9%)and 12.2%(95%CI 0-25.2%),respectively.The 3-year disease-free survival and overall survival rates were 73.3%(95%CI 56.2%-90.4%)and 79.1%(95%CI 62.2%-96.0%),respectively.Conclusions High-dose non-T-cell depleted PBSC used as grafts for RIC-haplo-HSCT can achieve good clinical efficacy in elderly patients with AML/MDS.

关 键 词：白血病 髓样 急性 骨髓增生异常综合征 造血干细胞移植 外周血造血干细胞 老年人 

分 类 号：R733.71[医药卫生—肿瘤]