引用本文:汤杨明,陆晓晨,谢艳梅,王八连,彭政棉,韦 琼,石仁州,李 含,李学军,蓝 梅.含克拉屈滨强化预处理方案异基因造血干细胞移植治疗第一次完全缓解期急性白血病的疗效和安全性观察[J].中国临床新医学,2023,16(11):1136-1141.
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含克拉屈滨强化预处理方案异基因造血干细胞移植治疗第一次完全缓解期急性白血病的疗效和安全性观察
汤杨明,陆晓晨,谢艳梅,王八连,彭政棉,韦 琼,石仁州,李 含,李学军,蓝 梅
530021 南宁,广西壮族自治区人民医院(广西医学科学院)血液内科
摘要:
[摘要] 目的 观察含克拉屈滨强化预处理方案异基因造血干细胞移植(allo-HSCT)治疗第一次完全缓解期(CR1)急性白血病(AL)的疗效和安全性。方法 回顾性分析2021年6月至2023年8月在广西壮族自治区人民医院血液内科移植中心接受含克拉屈滨强化预处理方案allo-HSCT治疗的11例CR1高危和微小残留病(MRD)阳性的低中危AL患者的临床资料,分析其一般资料、移植特征、造血重建情况以及生存情况。结果 11例患者移植后均获得造血重建,中性粒细胞中位植入时间为12(11~13)d,血小板中位植入时间为13(11~14)d。粒细胞植入前发生肺部感染2例,血流感染1例,抗感染治疗后均好转。4例发生Ⅰ~Ⅱ度急性移植物抗宿主病,4例发生慢性移植物抗宿主病,均为轻中度。中位随访时间为280(87~667)d,生存10例,死亡1例,预期1年的总生存率为90.00%,无病生存率为78.80%。结论 对处于CR1的高危和移植前MRD阳性的低中危AL,采用含克拉屈滨强化预处理方案能够降低复发率,改善总体生存,未增加预处理的相关毒性,具有较好的安全性。
关键词:  异基因造血干细胞移植  急性白血病  克拉屈滨  强化预处理方案
DOI:10.3969/j.issn.1674-3806.2023.11.07
分类号:R 733.71
基金项目:广西卫生健康委自筹经费科研课题(编号:Z-A20220096)
Observation on the efficacy and safety of allogeneic hematopoietic stem cell transplantation with the intensified conditioning regimen containing cladribine in treatment of acute leukemia in the first complete remission phase
TANG Yang-ming, LU Xiao-chen, XIE Yan-mei, et al.
Department of Hematology, the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning 530021, China
Abstract:
[Abstract] Objective To observe the efficacy and safety of allogeneic hematopoietic stem cell transplantation(allo-HSCT) with the intensified conditioning regimen containing cladribine in treatment of acute leukemia(AL) in the first complete remission phase(CR1). Methods The clinical data of 11 AL patients with high risk and measurable residual disease(MRD)-positive low/intermediate risk in CR1 who received allo-HSCT with the intensified conditioning regimen containing cladribine in the Transplantation Center of the Department of Hematology of the People′s Hospital of Guangxi Zhuang Autonomous Region from June 2021 to August 2023 were retrospectively analyzed. The general data, transplantation characteristics, hematopoietic reconstruction and survival of the patients were analyzed. Results After allo-HSCT, all the 11 patients attained hematopoietic reconstruction. The median time of neutrophil engraftment was 12(11-13)days, and the median time of platelet engraftment was 13(11-14)days. Pulmonary infection occurred in 2 cases and bloodstream infection in 1 case before granulocyte implantation, all of whom improved after anti-infection treatment. Grade Ⅰ-Ⅱ acute graft-versus-host disease(GVHD) occurred in 4 patients, and 4 cases developed mild to moderate chronic GVHD. The median follow-up time was 280(87-667)days, and 10 cases survived and 1 case died. The expected 1-year overall survival(OS) rate and the disease-free survival(DFS) rate were 90.00% and 78.80% respectively. Conclusion For the AL patients with high risk and MRD-positive low/intermediate risk in CR1 before transplantation, allo-HSCT with the intensified conditioning regimen containing cladribine can reduce the relapse rate and improve the OS, and has good safety without increasing the pretreatment-associated toxicity.
Key words:  Allogeneic hematopoietic stem cell transplantation(allo-HSCT)  Acute leukemia(AL)  Cladribine  Intensified conditioning regimen