摘要
目的:探讨氟达拉滨(Flu)联合后置环磷酰胺(CTX)预防单倍体造血干细胞移植中移植物抗宿主病(GVHD)的治疗方法。方法:29例患者接受常规BUCY-ATG预处理方案。52例患者接受PTCy(Flu+BUCY+后置CTX预处理)方案(CTX 50 mg/kg,+3 d及+4 d)。结果:中位随访时间为359 d,所有患者在第+30,+60天短串联重复序列(STR DNA)检测达到完全供体嵌合。PTCy组和BUCY-ATG组中性粒细胞计数≥0.5×10^(9)/L和血小板计数≥20×10^(9)/L的中位时间分别为(11.5 vs.12)d和(12 vs.13)d,Ⅱ~Ⅳ度急性GVHD(aGVHD)、Ⅲ~Ⅳ度aGVHD和慢性GVHD的累计发生率分别为(30.8%vs.31%)、(19.2%vs.24.1%)和(5.8%vs.24.1%)。累计总生存率(OS)和无病生存率(DFS)为65.5%vs.62.1%,1年时的非复发死亡率(NRM)为75%和77%。巨细胞病毒(CMV)感染和EB病毒(EBV)感染的发生率分别为(48.3%vs.50%)和(6.9%vs.3.7%)。结论:在缺乏HLA配型相合同胞供者和非亲缘全和供者的情况下,后置CTX的单倍体造血干细胞移植不失为一种较好的选择。但移植后的复发和感染仍然是影响患者长期存活的不良因素,寻找合适的移植方案仍然是当务之急。
AIM:To investigate the therapeutic method of fludarabine combined with subsequent cyclophosphamide in the prevention of GVHD in haploid hematopoietic stem cell transplantation.METHODS:A total of 52 patients receiving PTCY(50 mg/kg,on days 3 and 4)were matched with 29 patients receiving ATG.RESULTS:The median follow-up time was 359 days.Complete donor chimerism was achieved in all patients by STR DNA detection on days+30,+60.The median time to neutrophils≥0.5×10^(9)/L and platelets≥20×10^(9)/L were(11.5 vs.12)days and(12 vs.13)days respectively,between PTCy group and ATG group,The cumulative incidence of grade II-IV acute GVHD(aGVHD),gradeⅢ-IV aGVHD,and chronic GVHD were(30.8%vs.31%),(19.2%vs.24.1%)and(5.8%vs.24.1%)respectively.The cumulative overall survival(OS)and disease-free survival(DFS)were 65.5%vs.62.1%,the non-relapse-mortality(NRM)at 1 years were 75%and 77%.Incidence of CMV infection and EBV infection were(48.3%vs.50%)and(6.9%vs.3.7%).CONCLUSION:HLA-haploidentical HSCT with PTCy is a viable option when lack of HLA matched sibling and unrelated donors.The rate of severe GVHD is acceptable.But post-transplant relapse and infection still are major hinder,and the protocol should be modified.
作者
王甜甜
曹俊杰
刘旭辉
裴仁治
陆滢
WANG Tiantian;CAO Junjie;LIU Xuhui;PEI Renzhi;LU Ying(Department of Hematology,the Affiliated People's Hospital of Medical College of Ningbo University,Ningbo 315040,Zhejiang,China)
出处
《中国临床药理学与治疗学》
CAS
CSCD
2022年第3期295-301,共7页
Chinese Journal of Clinical Pharmacology and Therapeutics
基金
浙江省医药卫生科技计划项目(2017KY144)
宁波市鄞州区农业与社会发展科技项目(2019YZQ010001)。
