减低剂量预处理单倍型外周血造血干细胞移植治疗50岁以上恶性血液肿瘤患者的临床研究

OBJECTIVE: To analyze the efficacy of HLA-haploidentical peripheral hematopoietic stem cell transplantation (haplo-PBSCT) following reduced intensity conditioning (RIC) regimen to treat the patients with hematological malignancies who were older than 50 years old. METHODS: Eighteen patients with hematological malignancies over 50 years were enrolled, including 8 male and 10 female patients. The median age of all patients was 52 (range: 50–66) years. Of them, 8 patients had acute myeloid leukemia (AML), 2 chronic myelocytic leukemia (CML), 5 myelodysplastic syndrome (MDS), 2 acute lymphoblastic leukemia (ALL), and 1 aggressive natural killer cell leukemia (ANKL). All patients received fludarabine, cytarabine and melphalan with rabbit anti-human thymocyte globulin (FAB+rATG regimen) and transplanted with high dose non-T cell-depleted peripheral hematopoietic stem cells from donors. Enhanced graft versus host disease (GVHD) prophylaxis and infection prevention were administered. RESULTS: Fifteen days after transplantation, 16 patients achieved complete donor chimerism. One of them rejected the donor graft completely at thirty days after transplantation, and the other 2 patients had mixed chimerism 15 days after transplantation and converted to complete recipient chimerism at 30 days after transplantation. The cumulative incidence of acute GVHD (aGVHD) was 61.1% (95%CI49.6%–72.6%). The incidence of grade Ⅱ–Ⅳ aGVHD was 35.4% (95%CI 21.1%–49.7%), whereas grade III-IV was 13.8% (95%CI 4.7%–22.9%). The 2-year cumulative incidence of chronic GVHD (cGVHD) rate was estimated at 38.2% (95%CI 25.5%–50.9%). Patients were followed-up for a median of 14.5 months (range, 3–44 months). The Kaplan Meier estimates of 2-year overall survival (OS) and disease-free survival (DFS) was 72.6% (95%CI 60.1%–85.1%) and 63.7% (95%CI 49.2%–78.2%), respectively. The 2-year cumulative incidence of relapse and non-relapse-mortality (NRM) was 31.2% (95%CI 16.5%–45.9%) and 12.5% (95%CI 4.2%–20.8%), respectively. CONCLUSION: RIC-haplo-PBSCT protocol can achieve better results in patients with hematologic malignancies over 50 years old.