本文選題：地西他濱 + 異基因造血干細(xì)胞移植�。� 參考：《中國(guó)人民解放軍軍事醫(yī)學(xué)科學(xué)院》2017年碩士論文

【摘要】：第一部分含地西他濱預(yù)處理方案與標(biāo)準(zhǔn)預(yù)處理方案的異基因造血干細(xì)胞移植治療難治復(fù)發(fā)急性髓性白血病的臨床療效比較目的評(píng)估地西他濱聯(lián)合標(biāo)準(zhǔn)預(yù)處理方案異基因造血干細(xì)胞移植(allo-HSCT)治療難治復(fù)發(fā)急性髓性白血病(AML)的可行性和安全性,降低移植后的復(fù)發(fā)率,改善難治復(fù)發(fā)AML的不良預(yù)后。方法回顧性地分析2006年4月至2016年5月于我科接受含地西他濱預(yù)處理方案與標(biāo)準(zhǔn)預(yù)處理方案allo-HSCT治療的難治復(fù)發(fā)急性髓性白血病的臨床特征及療效。內(nèi)容收集27例接受標(biāo)準(zhǔn)預(yù)處理方案(BU/CY或者CY/TBI)allo-HSCT治療的難治復(fù)發(fā)AML患者作為對(duì)照組,20例接受高劑量地西他濱聯(lián)合標(biāo)準(zhǔn)預(yù)處理方案及18例接受低劑量地西他濱聯(lián)合標(biāo)準(zhǔn)預(yù)處理方案allo-HSCT治療的難治復(fù)發(fā)AML患者作為實(shí)驗(yàn)組,觀察患者的植入情況、移植相關(guān)死亡(TRM)、總生存(OS)率、無(wú)病生存(LFS)率及移植物抗宿主病(GVHD)的發(fā)生情況。結(jié)果標(biāo)準(zhǔn)預(yù)處理組、高劑量地西他濱組及低劑量地西他濱組患者的中性粒細(xì)胞以及血小板的中位植入時(shí)間分別為16(12-29)天和19(14-38)天、15(10-18)天和17.5(13-36)天、16(11-22)天和16.5(14-35)天,三組患者的中性粒細(xì)胞以及血小板的中位植入時(shí)間沒(méi)有統(tǒng)計(jì)學(xué)差異(p0.05)。標(biāo)準(zhǔn)預(yù)處理組有1名患者死于移植相關(guān)并發(fā)癥,移植相關(guān)死亡的累計(jì)發(fā)生率為4.2%。高劑量地西他濱組有4人死于移植相關(guān)并發(fā)癥,其中因感染死亡3人,1人死于心臟猝死,移植相關(guān)死亡的累計(jì)發(fā)生率為25.2%;低劑量地西他濱組有5人死于移植相關(guān)并發(fā)癥,其中因感染死亡3人,1人死于嚴(yán)重的GVHD,1人死于植入失敗,移植相關(guān)死亡的累計(jì)發(fā)生率為30.2%;標(biāo)準(zhǔn)預(yù)處理組共17人發(fā)生aGVHD、其中Ⅱ-Ⅳ度aGVHD有14(52.8%)人,Ⅲ-Ⅳ度aGVHD有6人。高劑量地西他濱組共8人發(fā)生aGVHD,其中Ⅱ-Ⅳ度aGVHD有2(10%)人,Ⅲ-Ⅳ度aGVHD有0人;低劑量地西他濱組共10人發(fā)生aGVHD,其中Ⅱ-Ⅳ度aGVHD有7(45.3%)人,Ⅲ-Ⅳ度aGVHD有2人,其中1人死于激素耐藥的重度aGVHD;標(biāo)準(zhǔn)預(yù)處理組患者的Ⅱ-Ⅳ度aGVHD的發(fā)生率明顯高于高劑量地西他濱組,差異有統(tǒng)計(jì)學(xué)意義(p=0.0290.05),但與低劑量地西他濱組相比,沒(méi)有發(fā)現(xiàn)統(tǒng)計(jì)學(xué)差異。標(biāo)準(zhǔn)預(yù)處理方案組、高劑量地西他濱理組和低劑量地西他濱組的1年總體生存(OS)率分別為22.2%,68.8%和27.8%(p=0.0070.05);標(biāo)準(zhǔn)預(yù)處理方案組、高劑量地西他濱組和低劑量地西他濱組的1年無(wú)病生存(LFS)率分別為22.2%,58.5%和20.8%(p=0.0230.05)。結(jié)論1、高劑量地西他濱用于移植標(biāo)準(zhǔn)預(yù)處理方案可能降低難治復(fù)發(fā)AML患者移植后Ⅱ-Ⅳ度aGVHD的發(fā)生率2、高劑量地西他濱聯(lián)合標(biāo)準(zhǔn)預(yù)處理方案的allo-HSCT可以減少難治復(fù)發(fā)AML患者移植后的復(fù)發(fā)風(fēng)險(xiǎn),提高患者的總體生存和無(wú)病生存,使患者生存獲益第二部分地西他濱強(qiáng)化預(yù)處理與去甲氧柔紅霉素強(qiáng)化預(yù)處理的異基因造血干細(xì)胞移植治療難治復(fù)發(fā)急性髓性白血病的臨床療效比較目的分析地西他濱與去甲氧柔紅霉素強(qiáng)化預(yù)處理方案造血干細(xì)胞移植(allo-HSCT)治療難治復(fù)發(fā)急性髓性白血病(AML)的臨床療效方法回顧性地分析2009年7月至2016年5月于我科接受高劑量地西他濱(DAC)及去甲氧柔紅霉素(IDA)強(qiáng)化預(yù)處理allo-HSCT治療的44名難治復(fù)發(fā)AML患者的臨床資料。內(nèi)容收集接受高劑量地西他濱強(qiáng)化預(yù)處理allo-HSCT治療的難治復(fù)發(fā)AML患者18人,接受去甲氧柔紅霉素強(qiáng)化預(yù)處理allo-HSCT治療的難治復(fù)發(fā)AML患者26人,兩組患者移植前均處于未緩解狀態(tài)。觀察患者的植入情況、移植相關(guān)死亡(TRM)、總生存(OS)率、無(wú)病生存(LFS)率及移植物抗宿主病(GVHD)發(fā)生情況。結(jié)果接受強(qiáng)化預(yù)處理方案allo-HSCT治療的44名難治復(fù)發(fā)AML患者均植入成功,地西他濱組中性粒細(xì)胞以及血小板的中位植入時(shí)間分別為15(10-18)天和18(13-36)天,去甲氧柔紅霉素組中性粒細(xì)胞以及血小板的中位植入時(shí)間分別為14(12-22)天和19(14-35)天,兩組患者中性粒細(xì)胞以及血小板中位植入時(shí)間沒(méi)有發(fā)現(xiàn)統(tǒng)計(jì)學(xué)差異(p0.05)。地西他濱組有4(22.2%)人死于移植相關(guān)并發(fā)癥,其中因感染死亡3人,1人死于心臟猝死,僅2(11.1%)人死于白血病復(fù)發(fā);去甲氧柔紅霉素組有2(7.7%)人死于移植后的感染并發(fā)癥,9(34.6%)人死于白血病復(fù)發(fā)。高劑量地西他濱組共7(38.9%)人發(fā)生a GVHD,其中Ⅰ度2例,Ⅱ度5例,無(wú)一人發(fā)生Ⅲ-Ⅳ度a GVHD;去甲氧柔紅霉素組共16(61.5%)人發(fā)生a GVHD,其中Ⅰ度9例,Ⅱ度6例,Ⅲ度1人,地西他濱組患者的a GVHD的發(fā)生率要低于去甲氧柔紅霉素組,但差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。地西他濱組和去甲氧柔紅霉素組的1年總體生存(OS)率分別為65.0%和57.7%,差異沒(méi)有統(tǒng)計(jì)學(xué)意義(p=0.602);地西他濱組和去甲氧柔紅霉素組的1年無(wú)病生存(LFS)率分別為53.5%和57.7%,差異無(wú)統(tǒng)計(jì)學(xué)意義(p=0.910)。結(jié)論1、地西他濱強(qiáng)化預(yù)處理方案allo-HSCT治療難治復(fù)發(fā)AML是安全且有效的;2、地西他濱組a GVHD的發(fā)生率要低于去甲氧柔紅霉素組,但由于我們此次的回顧性研究樣本量較少,差異沒(méi)有統(tǒng)計(jì)學(xué)意義;3、地西他濱用于強(qiáng)化預(yù)處理方案,可以取得不弱于去甲氧柔紅霉素強(qiáng)化方案的臨床療效,且并沒(méi)有增加預(yù)處理的毒性。
[Abstract]:The first part of the clinical efficacy of allogeneic hematopoietic stem cell transplantation with standard preconditioning regimen and standard preconditioning regimen for refractory and recurrent acute myelogenous leukemia: Objective To evaluate the treatment of refractory and relapsed acute myelogenous leukemia (AML) with allo-HSCT It is feasible and safe to reduce the recurrence rate after transplantation and improve the poor prognosis of refractory recurrent AML. Methods the clinical features and efficacy of 27 cases of refractory and recurrent acute myelopathy in our department from April 2006 to May 2016 were retrospectively analyzed. The clinical features and efficacy of 27 cases of refractory and recurrent acute myelopathy were analyzed. The refractory and relapsed AML patients received standard preconditioning (BU/CY or CY/TBI) allo-HSCT treatment as the control group, 20 patients received high dose of hitabine combined standard preconditioning and 18 cases of refractory relapsed AML patients treated with low dose western itabine combined standard preconditioning regimen as the experimental group, to observe the patient's implantation. Cases of transplant related death (TRM), total survival (OS), disease free survival (LFS) and graft-versus-host disease (GVHD). Results standard preconditioning group, high dose of hitabine group and low dose of low dose Xi tanbin group were 16 (12-29) days and 19 (14-38) days, 15 (10-18) days, respectively. With 17.5 (13-36) days, 16 (11-22) days and 16.5 (14-35) days, there was no statistical difference in the median implantation time of neutrophils and platelets in three groups (P0.05). There were 1 patients in the standard preconditioning group died of transplant related complications, and the cumulative incidence of transplantation related deaths was about 4 in 4.2%. high dose and 4 people died of transplant correlation. 3 people died of infection and 1 died of sudden cardiac death. The cumulative incidence of transplantation related deaths was 25.2%. 5 people died of transplant related complications in the low dose of the group. 3 of them died, 1 died of severe GVHD, 1 died of implantation failure, and the cumulative incidence of transplant related deaths was 30.2%; a standard preconditioning group shared a total of 30.2%. 17 people had aGVHD, of which there were 14 (52.8%) people with grade II - IV degree aGVHD and 6 degree aGVHD in grade III - IV degree. A total of 8 people were aGVHD in the high dose of hitabine group, of which 2 (10%) of aGVHD degree aGVHD had 2 (10%), and 0 of the degree III to IV degree, and 10 in the low dose to 10 people, of which there were 7 (45.3%) and III to IV degree aGVHD, among which there were 2 people, among which 1 died of excitement. The incidence of aGVHD in the standard pretreated group was significantly higher than that of the high dose of the seitribin group. The difference was statistically significant (p=0.0290.05), but there was no statistical difference compared with the low dose of selitabine group. The standard preconditioning regimen, the high dose of the West littoral group and the low dose of the West itabine group The 1 year overall survival (OS) rates were 22.2%, 68.8% and 27.8% (p=0.0070.05); the 1 year disease-free survival (LFS) rates of the high dose of the hitabine group and the low dose of the low dose of the hitabine group were 22.2%, 58.5% and 20.8% (p=0.0230.05). Conclusion 1. The high dose of hitabine for transplantation standard preconditioning regimen may reduce the recurrence of refractory recurrence. The incidence of II - IV degree aGVHD after transplantation of AML patients was 2. High dose of xitabine combined with standard preconditioning regimen could reduce the recurrence risk of refractory and relapsed AML patients after transplantation, improve the overall survival and disease free survival of the patients, and make the patient's survival benefit second parts of the fortified preconditioning and the strengthening of nordoxorubicin. Comparison of the clinical efficacy of pretreated allogeneic hematopoietic stem cell transplantation for refractory and recurrent acute myeloid leukemia objective analysis of the clinical efficacy of sxhitabine and allo-HSCT for refractory and relapsed acute myelogenous leukemia (AML) in the treatment of refractory and recurrent acute myelogenous leukemia (AML) in July 2009 To May 2016, the clinical data of 44 refractory recurrent AML patients treated with high dose of DAC and IDA enhanced preconditioning with allo-HSCT were received in our department. The content of 18 patients with refractory recurrent AML with high dose of xalbebin preconditioning allo-HSCT treatment was collected, and the fortified preconditioning of nordoxorubicin was received. 26 patients with refractory recurrent AML treatment were treated with allo-HSCT treatment. The two groups were in unremission state before transplantation. The patient's implantation, transplantation related death (TRM), total survival (OS), disease free survival (LFS) and graft-versus-host disease (GVHD) were observed. 44 refractory recurrent AML in allo-HSCT treatment with fortified preconditioning regimen. The implantation time of neutrophils and platelets in the group was 15 (10-18) days and 18 (13-36) days respectively. The median time of neutrophils and platelets were 14 (12-22) days and 19 (14-35) days, respectively, in the two group of neutrophils and platelets, and the time of implanting of neutrophils and platelets in the two group. There were no statistical differences (P0.05). 4 (22.2%) died of transplant related complications in the sxitabine group, of which 3 died of infection, 1 died of sudden cardiac death, and only 2 (11.1%) died of leukemia relapse; 2 (7.7%) died of infection complications after transplantation and 9 (34.6%) died of leukemia relapse. High dose XXX A total of 7 (38.9%) people in the riparian group had a GVHD, including 2 cases of degree I, 5 cases of degree II and no one degree a GVHD; 16 (61.5%) people of nordioxubicin group had a GVHD, of which 9 cases, 6 cases, and 1 people, and the incidence of a GVHD in the patients with dioxin group was lower than that of the daunorubicin group, but the difference was not statistically significant (P0.05). The difference was not statistically significant (P0.05). The total 1 year survival (OS) rate of the xitabine group and nordoxorubicin group was 65% and 57.7%, respectively, and the difference was not statistically significant (p=0.602). The 1 year disease-free survival (LFS) rate of the saxorubicin group and the dimethoxubicin group was 53.5% and 57.7%, respectively (p=0.910). Conclusion 1, p=0.602 preconditioning regimen allo-HS CT treatment for refractory AML is safe and effective; 2, the incidence of a GVHD in sxhitabine group is lower than that of nordoxorubicin group, but the difference is not statistically significant because of our retrospective study sample size, and 3. The bed was effective and did not increase the toxicity of preconditioning.
【學(xué)位授予單位】：中國(guó)人民解放軍軍事醫(yī)學(xué)科學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R733.71

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 周進(jìn);王婧;劉輝;鄭慧菲;馬玲;王攀峰;顏霜;吳德沛;傅t$t$;仇惠英;唐曉文;金正明;韓悅;苗瞄;;含地西他濱方案橋接異基因造血干細(xì)胞移植治療MDS/AML的效果評(píng)估[J];中華醫(yī)學(xué)雜志;2015年12期

2 李鑫雨;王欣;李穎;封麗麗;周慧;單寧寧;丁梅;;去甲氧柔紅霉素與柔紅霉素聯(lián)合阿糖胞苷方案治療74例初治急性髓系白血病患者療效分析[J];中華血液學(xué)雜志;2013年01期

3 王昱;劉代紅;劉開彥;許蘭平;張曉輝;韓偉;陳歡;陳育紅;王峰蓉;王景枝;付海霞;黃曉軍;;單倍型異基因造血干細(xì)胞移植治療難治/復(fù)發(fā)急性白血病患者的療效觀察[J];中華血液學(xué)雜志;2012年11期

4 王文娟;孫愛(ài)寧;仇惠英;李渭陽(yáng);;IA與MA方案誘導(dǎo)治療初治急性髓系白血病的療效比較[J];中華血液學(xué)雜志;2011年12期

5 趙淑清;李軍民;沈志祥;;去甲氧柔紅霉素在血液腫瘤治療中的應(yīng)用[J];中華血液學(xué)雜志;2006年01期

，

本文編號(hào)：2053610