摘要:
Objective To explore the effect and feasibility of reduced intensity allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of relapsed or refractory acute myeloid leukemia (AML) in elderly patients.Methods Six elderly patients with relapsed or refractory AML received reduced intensity conditioning allo-HSCT from January 2012 to January 2014 in Beijing Military Region General Hospital,including 5 males and 1 females,aged from 61 to 68 years old with mean age of 64.6 years old.Donors received granulocyte colony-stimulating factor to mobilize and used peripheral blood stem cell transplantation.Pretreatment scheme was reduced the strength of pretreatment for fludarabine combined with busulfex and cytarabine,cyclophosphamide.Preventive donor peripheral blood stem cell infusion was used after 3 months of transplantation and observed toxicity,GVHD and disease-free survival in patients after transplantation.Results All patients reached hematopoietic reconstitution,the average time were 21.5 d and 24.2 d respectively with neutrophils ≥0.5×109/L and platelets ≥20×109/L.Implantation was confirmed by the evidence of 100 % of donor hematopoiesis.With a median follow-up duration of 11.5 months (5~18 months),three cases occurred GVHD in all patients,one died of GVHD and other two cases died of relapse,the other three patients remained disease-free survival,the disease-free survival rate of 2-year was 50 %,the longest disease-free survival time up to 30 months.Conclusion Reduced intensity allo-HSCT is an effective therapeutic method for relapsed or refractory AML in elderly patients.%目的 探讨减低强度预处理异基因造血干细胞移植(allo-HSCT)治疗老年人复发难治性急性髓系白血病(AML)的疗效和安全性.方法 采用减低强度预处理的allo-HSCT治疗北京军区总医院2012年1月至2014年1月收治的6例老年人复发难治性AML,其中男5例,女1例,年龄61~68岁,平均年龄64.6岁,供者接受粒细胞集落刺激因子动员,均采用外周血干细胞移植,预处理方案为降低预处理强度的氟达拉滨联合白消安注射液(商品名:白舒非)、阿糖胞苷及环磷酰胺等,移植物抗宿主病(GVHD)预防采用联合免疫抑制剂,移植后3个月进行预防性供者外周血干细胞输注,观察全部患者不良反应、GVHD和无病生存等情况.结果 全部患者获造血重建,中性粒细胞≥0.5×109/L及血小板计数≥20×109/L的平均时间分别为21.5 d及24.2 d,植入证据检测证实为100%为完全供者造血.中位随访18.5个月(5~30个月),共3例发生GVHD,GVHD死亡1例,复发死亡2例,复发时间为11.5个月(5~ 18个月),其余3例患者仍无病生存,2年的无病生存率为50%,最长无病生存时间已达30个月.结论 减低强度预处理的allo-HSCT是复发老年人AML挽救性治疗的可行方法.