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目的评价采用氟达拉滨(Flu)和阿糖胞苷(Ara-c)改良的预处理方案进行自体造血干细胞移植(AHSCT)治疗急性白血病的安全性和疗效。方法27例急性白血病患者,其中男性18例,女性9例;年龄12～51岁,中位年龄20岁。急性淋巴细胞白血病(ALL)21例;急性髓细胞性白血病(AML)5例。均采用包含Flu和Ara-c的预处理方案进行AHSCT,方案包括全身照射(TBI)7～8Gy或白消胺(Bu)3.2mg/(kg·d)×3d联合环磷酰胺(Cy)50mg/(kg·d)×2d、Flu30mg/(m2·d)×3d、Ara-c2g/(m2·d)×3d。结果除1例患者早期死亡外,所有患者均成功重建造血系统,中性粒细胞恢复至大于0.5×109/L、血小板恢复至20×109/L的中位时间分别为11(9～19)d和16(10～55)d。预处理过程中无严重不良事件发生,移植相关死亡率(TRM)7.4%(2例)。4年总体复发率(RR)、TRM和无病生存率(DFS)分别为38.8%±10.3%、9.3%±5.7%、60.8%±9.8%。结论在AHSCT治疗急性白血病中,以Flu、Ara-c改良的TBI/Cy或Bu/Cy预处理方案髓外毒性小,无病生存率较高,可作为急性白血病预处理的一种有效选择。
Objective To evaluate the safety and efficacy of autologous hematopoietic stem cell transplantation (AHSCT) in the treatment of acute leukemia using fluconazole and cytarabine (Ara-c). Methods 27 cases of acute leukemia patients, including 18 males and 9 females; aged 12 to 51 years, with a median age of 20 years. 21 cases of acute lymphoblastic leukemia (ALL); 5 cases of acute myeloid leukemia (AML). AHSCT was performed with a pretreatment regimen containing Flu and Ara-c. The regimen consisted of 7-8 Gy of whole body irradiation (TBI) and 50 mg of cyclophosphamide (Cy) with 3.2 mg / (kg · d) / (kg · d) × 2d, Flu30mg / (m2 · d) × 3d, Ara-c2g / (m2 · d) × 3d. Results All of the patients successfully reconstructed the hematopoietic system except for one patient died early. The neutrophil recovered to more than 0.5 × 109 / L and the median time to platelet recovery to 20 × 109 / L was 11 (9-19) d and 16 (10-55) d. No serious adverse events occurred during the pretreatment, and graft-related mortality (TRM) was 7.4% (two patients). The overall recurrence rate (RR), TRM and DFS at 4 years were 38.8% ± 10.3%, 9.3% ± 5.7% and 60.8% ± 9.8%, respectively. Conclusion AHSCT treatment of acute myeloid leukemia with Flu, Ara-c modified TBI / Cy or Bu / Cy pretreatment regimen has low extramedullary toxicity and higher disease-free survival rate, which can be used as an effective treatment for acute leukemia pretreatment.