二次异基因造血干细胞移植治疗移植后复发患者的疗效和安全性

目的 探讨应用二次异基因造血干细胞移植治疗移植后复发患者的疗效和安全性.方法 回顾性分析1999年10月-2010年3月在北京大学血液病研究所接受二次造血干细胞移植作为挽救治疗的25例移植后复发患者的资料.除1例移植前未达缓解状态的患者外,其余24例患者在第1次移植后的中位8.8(1～55)个月出现复发,经过中位3(0.3～20)个月的治疗,接受了二次移植.2次移植中位间隔10.6(0.6～59.0)个月.结果 25例患者预处理方案主要为含全身放疗(TBI)或改良的BUCY(马利兰+环磷酰胺)方案.全部患者达到白细胞植活标准,并生存超过30 d,有3例患者发生肝窦阻塞综合征,放射性皮炎以及急性心肌梗死等严重预处理相关毒性,但经治疗后均恢复.截至2011年1月,经过中位9.1(2.0～131.1)个月的随访,8例患者生存,总的生存率为30.9%.12例患者复发,复发率55.7%,复发中位时间是二次移植后的4.4(1.0～8.5)个月.7例患者因移植相关合并症死亡,非复发病死率35.1%.单因素分析发现患者二次移植时是否缓解与生存期有显著关联(P=0.009).结论 适度降低强度的预处理方案可以使二次异基因造血干细胞移植安全地应用于移植后复发的患者,保证移植物的植入,非复发病死率亦在可接受范围内.

The efficacy and safety of second allogeneic hematopoietic stem cell transplantation for post-transplant hematologic malignancies relapse

Objective To investigate the safety and efficacy of second allogeneic hematopoietic stem cell transplantation for the relapsed hematologic malignancies. Methods The data of 25 relapsed patients received the second allogeneic transplantation as a salvage therapy in Institute of Hematology Peking University between October 1999 and March 2010 were analyzed retrospectively. Twenty-four patients relapsed at 8. 8 (1-55) months after the first transplantation, except one received the second transplantation as prophylaxis therapy. They received the second transplantation after 3(0. 3-20) months' therapy. The median time between the 2 transplants was 10. 6(0. 6-59. 0) months. Results Most of the patients were given the conditioning regimen including total body irradiation (TBI, 700-779 cGy) or modified busulfan and cyclophosphamide (BUCY, BU 12 mg). All patients survived more than 30 days and achieved sustained white blood cell engraftment. Sinus obstructive syndrome, irradiation dermatitis and acute myocardial infraction were occurred in 3 patients and recoverable. Until January 31 in 2011, with a median observation period of 9. 1 (2. 0-131. 1) months, 8 patients had been living with a overall survival (OS) of 30.9%.Twelve patients relapsed at a median 4. 4 months and 10 died of it. The other 7 patients died of transplant related complications. The non-relapsed mortality was 35. 1 %. The disease status at the 2nd transplantation was the only factor which effected the OS (P = 0. 009). Conclusions The second allogeneic transplantation is a viable option for patients relapsing after the first transplantation. Reduced intensive conditioning regimen ensures the graft engraftment and reduces transplant related toxicity.