含地西他滨清髓预处理方案的异基因造血干细胞移植治疗急性髓系白血病的疗效和安全性分析  

Efficacy and Safety of Decitabine-Based Myeloablative Precondi-tioning Regimen for allogeneic Hematopoietic Stem Cell Trans-plantation in Patients with Acute Myeloid Leukemia

作　　者：张夏玮 杨晶晶 乐凝 魏宇君 温亚男 王楠 焦一帆 栾松华 窦立萍 高春记 ZHANG Xia-Wei;YANG Jing-Jing;LE Ning;WEI Yu-Jun;WEN Ya-Nan;WANG Nan;JIAO Yi-Fan;LUAN Song-Hua;DOU Li-Ping;GAO Chun-Ji(Medical School of Chinese PLA;Department of Hematology,The Fifth Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院 [2]解放军总医院第五医学中心血液病医学部,北京100853

出　　处：《中国实验血液学杂志》2025年第2期557-564,共8页Journal of Experimental Hematology

基　　金：国家自然科学基金(No.82070178、82270162、82270224);国家重点研发计划(No.2021YFA1100904);北京市自然科学基金(No.7222175);军队卫勤保障能力创新与生成专项(No.21WQ034);保健专项科研课题重点项目(21BJZ30)。

摘　　要：目的:分析含地西他滨清髓预处理方案用于急性髓系白血病(AML)患者异基因造血干细胞移植(allo-HSCT)的疗效和安全性。方法:回顾性分析2018年8月到2022年8月于解放军总医院第一医学中心进行allo-HSCT的115例AML患者的临床特征及疗效,包括使用含地西他滨清髓预处理方案(含地西他滨组)的患者37例,不含地西他滨清髓预处理方案(非地西他滨组)的患者78例,分析患者累积复发率(CIR)、总体生存(OS)率、无白血病生存(LFS)率、非复发死亡率(NRM)及移植物抗宿主病(GVHD)等指标。结果:移植前为首次完全缓解(CR1)状态的患者中,含地西他滨组(22例)和非地西他滨组(69例)的移植后1年累积复发率分别为9.1%和29.6%,比较差异有统计学意义(P=0.042)。含地西他滨组与非地西他滨组急性移植物抗宿主病(aGVHD)1年累积发生率分别为62.2%和70.5%,慢性移植物抗宿主病(cGVHD)1年累积发生率分别为18.9%和14.1%,两组患者的aGVHD发生率和cGVHD发生率比较均无统计学差异(P>0.05)。115例患者中,含地西他滨组(37例)与非地西他滨组(78例)的移植后1年CIR(21.7%对28.8%,P=0.866)、NRM(10.9%对3.9%,P=0.203)、OS(75.2%对83.8%,P=0.131)和LFS(74.6%对69.1%,P=0.912)差异无统计学意义。结论:使用含地西他滨的预处理方案的allo-HSCT治疗可降低AML CR1患者复发率,安全性良好。Objective:To analyze the efficacy and safety of decitabine-based myeloablative preconditioning regimen for allogeneic hematopoietic stem cell transplantation(allo-HSCT)in patients with acute myeloid leukemia(AML).Methods:The clinical characteristics and efficacy of 115 AML patients who underwent allo-HSCT at the First Medical Center of Chinese PLA General Hospital from August 2018 to August 2022 were retrospectively analyzed,including 37 patients treated with decitabine conditioning regimen(decitabine group)and 78 patients without decitabine conditioning regimen(non-decitabine group).The cumulative incidence of relapse(CIR),overall survival(OS),leukemia-free survival(LFS),non-relapse mortality(NRM)and graft versus host disease(GVHD)were analyzed.Results:For the patients in first complete remission(CR1)state before allo-HSCT,the 1-year relapse rates of decitabine group(22 cases)and non-decitabine group(69 cases)were 9.1%and 29.6%,respectively,the difference was statistically significant(P=0.042).The 1-year cumulative incidence of acute graft-versus-host disease(aGVHD)in decitabine group and non-decitabine group was 62.2%and 70.5%,respectively,and the 1-year cumulative incidence of chronic inhibitor-versus-host disease(cGVHD)was 18.9%and 14.1%,respectively,there were no significant differences in the incidence of aGVHD and cGVHD between the two groups(P>0.05).Of the 115 patients,there were no significantly differences in the 1-year CIR(21.7%vs 28.8%,P=0.866),NRM(10.9%vs 3.9%,P=0.203),OS(75.2%vs 83.8%,P=0.131)and LFS(74.6%vs 69.1%,P=0.912)between the decitabine group(37 cases)and the non-decitabine group(78 cases).Conclusion:Decitabine-based conditioning regimen could reduce the relapse rate of AML CR1 patients with good safety.

关 键 词：地西他滨 移植前预处理 急性髓系白血病 

分 类 号：R733.71[医药卫生—肿瘤]