摘要
目的探讨使用＂氟达拉滨＋马利兰（Flud＋Bu）＂预处理方案行异基因造血干细胞移植治疗白血病的临床疗效。方法6例患者中,慢性粒细胞白血病（CML）慢性期2例,急性淋巴细胞白血病（L2型）2例,急性非淋巴细胞白血病（M5型）1例,骨髓增生异常综合征（MDS）转化急非淋白血病1例。预处理方案包括氟达拉滨30 mg/（m2·d）×4 d,注射用马利兰3.2 mg/（kg·d）×2-4 d;非血缘移植患者加用兔抗人胸腺细胞球蛋白（ATG）2.5 mg/（kg·d）×3 d;供者为其HLA配型相合的同胞或非血缘;输注外周血造血干细胞数合计CD34＋细胞3.0-8.03×10^6/kg（平均4.29×10^6/kg）,单个核细胞6.74-13.51×10^8/kg（平均9.01×10^8/kg）;采用＂环孢霉素＋短疗程甲氨喋呤＂预防移植物抗宿主病（GVHD）。结果所有患者均未发生严重的预处理相关并发症;其中5例患者重建造血,检测外周血白细胞STR-DNA证实均为完全供者植入;1例急淋L2患者在移植后早期（〈30 d）白血病复发导致死亡,其余5例患者随访8-20个月（中位时间10个月）均存活,至今无白血病复发。结论＂氟达拉滨＋马利兰＂预处理方案移植相关并发症轻,治疗恶性血液病安全可行,远期疗效尚待评估。
Objective To explore the clinical efficacy of fludarabine plus busulfan conditioning regimen for allogeneic hematopoietic stem cell transplantation（allo-HSCT） in treating leukemia patients.Methods Of the 6 patients,2 had chronic myelogenous leukemia in their chronic phase,2 had acute lymphoid leukemia,1 had acute myeloid leukemia and 1 had acute myeloid leukemia transformed from myelodysplastic syndrome（MDS）.The conditioning regimen included fludarabine 30mg/m^2·d for 4 days,intravenous injection of busulfan 3.2mg/kg·d for 2 to 4 days,and rabbit anti-human thymocyte globulin 2.5mg/kg·d for 3 days in patients with unrelated donor.The number of infused peripheral blood stem cells was 3.0-8.03×10^6 CD34^＋ cells/kg（average of 4.29×10^6/kg） and that of peripheral blood mononuclear cells was 6.74-13.51×10^8 cells/kg（average of 9.01×10^8/kg）.Cyclosporine and short-term methotrexate were used to prevent graft-versus-host disease.Results No severe regimen-related toxicity occurred in any of the patients.Five patients achieved hematopoiesis recomstruction with their full donor chimerisms confirmed by STR-DNA analysis.The other one had leukemia relapse within one month after HSCT.Except the early-relapsing patient who died later,the other 5 patients remained alive without relapse in the follow-up duration of 8 to 20 months（median of 10 months）.Conclusion The conditioning regimen with fludarabine plus busulfan is safe and effective in treating patients with hematopoietic malignant diseases with fewer complications.The long-term efficacy needs further evaluation.
出处
《西安交通大学学报（医学版）》
CAS
CSCD
北大核心
2010年第3期328-331,共4页
Journal of Xi’an Jiaotong University（Medical Sciences）
基金
国家自然科学基金资助项目(No.30800493)~~
关键词
造血干细胞移植
白血病
预处理
氟达拉滨
疗效
hematopoietic stem cell transplantation
leukemia
conditioning regimen
fludarabine
curative effect
