地西他滨强化预处理方案造血干细胞移植治疗难治复发急性髓性白血病的临床研究

摘要

Objective To observe the treatment results of 44 consecutive patients with refractory/relapse acute myeloid leukemia( AML) not in remission who received allogeneic hematopoietic stem cell transplantation ( allo-HSCT ) following decitabine (DAC)-intensified conditioning regimen (18) and idarubicin(IDA)-intensified conditioning regimen (26). Methods We conducted a retrospective study to evaluate the outcome of 44 consecutive patients with refractory/relapse AML not in remission who received allo-HSCT from 2009 July to 2016 May.Eighteen of them were given DAC-intensified conditioning regimen and 26 of them were given IDA-intensified conditioning regimen prior to allo-HSCT.The effects of DAC and IDA intensified conditioning regimen on the patients ' engraftment, transplant-related mortality, survival and occurrence of graft versus host disease(GVHD)were analyzed.Results and Conclusion In the DAC group, 7(38.9％) patients had acute GVHD (aGVHD).Among them,2 patients had grade Ⅰ aGVHD,5 patients had grade Ⅱ aGVHD.In the IDA group, 16(61.5％)patients had aGVHD.Among them,9 patients had grade Ⅰ aGVHD, 6 patients had grade Ⅱ aGVHD and 1 patient had grade ⅢaGVHD.In the IDA group, 9 of 26(34.6％) patients experienced leukemia relapse , all of them died due to the lack of effective therapies .In the DAC group, 4 of 18(22.2％) patients experienced leukemia relapse, 2 of them got long-term survival throughout salvage therapies .For the DAC group and IDA group , the 1-year probabilities of overall survival (OS) and leukemia-free survival (LFS) were 65.0％ versus 57.7％ (P=0.602) and 53.5％versus 57.7％(P=0.910), respectively.DAC-intensified conditioning regimen before allo-HSCT in the treatment of refractory/relapse AML is safe and effective.%目的 观察地西他滨(DAC)强化预处理方案异基因造血干细胞移植(allo-HSCT)治疗难治复发急性髓性白血病(AML)的临床疗效.方法 回顾性分析2009年7月至2016年5月于军事医学科学院附属医院造血干细胞移植科接受DAC及去甲氧柔红霉素(IDA)强化预处理allo-HSCT治疗的44例难治复发AML患者的临床特征及疗效.结果与结论 两组患者均植入成功. DAC组7例( 38 .9％)发生急性移植物抗宿主病( GVHD ) ,其中Ⅰ度2例,Ⅱ度5例,无1例发生Ⅲ～Ⅳ度GVHD;IDA组16例(61.5％)发生GVHD,其中Ⅰ度9例,Ⅱ度6例,Ⅲ度1例.DAC组和IDA组的1年总体生存(OS)分别为65.0％和57.7％(P=0.602);两组的1年无病生存(LFS)分别为57.7％和53.5％(P=0.910). DAC强化预处理方案allo-HSCT治疗难治复发AML安全且有效.