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目的:评价氟达拉滨(Flu)联合静脉马利兰(Bu)的预处理方案在髓系恶性血液病患者异基因造血干细胞移植(allo-HSCT)中的疗效及静脉Bu的最佳剂量。方法:45例接受allo-HSCT的髓系恶性血液病患者,预处理方案主要采用Bu3.2mg·kg-1.d-1×2～4d,Cy40～50mg/kg×2d,Flu30mg.m-2.d-1×3d,Ara-C2g.m-2.d-1×3d,无关供者移植同时加用兔抗人血清免疫球蛋白(ATG)2.5mg/kg×4d。按静脉Bu用量进一步分为2d组17例,3d组18例,4d组10例。结果:预处理过程无严重不良事件发生,无肝静脉闭塞病(VOD)发生,Ⅱ～Ⅳ度急性移植物抗宿主病(aGVHD)9例(20%),100d移植相关死亡(TRM)1例(2.2%),3年TRM15例(33.3%),3年累计复发3例(6.7%),3年无病生存率(DFS)和3年总体生存率(OS)分别为(60.5±7.5)%和(62.2±7.2)%。与Bu2d组和3d组比较,4d组患者的慢性GVHD的发生率显著增高,TRM有增高趋势;OS显著降低,DFS有降低趋势。结论:Flu联合静脉Bu的预处理方案治疗髓系恶性血液病具有较低的髓外毒性反应和较好的耐受性,移植疗效与经典预处理方案相当。
OBJECTIVE: To evaluate the efficacy of Fluconazole combined with venous marilan (Bu) in the treatment of myeloid hematologic malignancies allogeneic hematopoietic stem cell transplantation (allo-HSCT) and the best dose of intravenous Bu. Methods: Forty-five patients with myeloid hematologic malignancies undergoing allo-HSCT were treated with Bu3.2mg · kg-1.d-1 × 2 ~ 4d, Cy40 ~ 50mg / kg × 2d, Flu30mg.m-2 .d-1 × 3d and Ara-C2g.m-2.d-1 × 3d, allograft donation plus rabbit anti-human serum immunoglobulin (ATG) 2.5mg / kg × 4d. According to the amount of intravenous Bu was further divided into 2d group 17 cases, 3d group 18 cases, 4d group 10 cases. Results: There were no serious adverse events during the pretreatment. There was no occurrence of hepatic veno-occlusive disease (VOD), 9 cases (20%) of Ⅱ ~ Ⅳ acute graft-versus-host disease (aGVHD), 1 case of transplant-related death (TRM) (2. 2%), 3 cases of TRM in 15 cases (33.3%), 3 years of cumulative recurrence in 3 cases (6.7%), 3 years disease free survival (DFS) and 3 years overall survival (OS) % And (62.2 ± 7.2)%. Compared with Bu2d group and 3d group, the incidence of chronic GVHD in 4d group was significantly higher, TRM increased; OS decreased significantly, DFS decreased. Conclusion: Flu combined with intravenous Bu pretreatment regimen in the treatment of myeloid hematopoietic malignancies with lower extramedullary toxicity and better tolerability, transplantation and the efficacy of the classic pretreatment program.