[Haploidentical nonmyeloablative allogeneic peripheral blood stem cell transplantation for treatment of refractory or relapsed leukemia: long-term follow-up]

To observe the therapeutic effect and major complications of haploidentical nonmyeloablative allogeneic peripheral blood stem cell transplantation (NST) for refractory or relapsed leukemia.The results of 30 patients, including 14 cases of acute myeloid leukemia (AML), 11 cases of acute lymphoblastic leukemia (ALL), 5 case of chronic myelogenous leukemia (CML) (accelerated and blastic phase) with refractory or relapsed leukemia (RF/RL) who underwent haploidentical NST from August 2000 to April 2009 were analyzed. The conditioning regimen consisted of fludarabine (flu), antithymocyte globulin (ATG), cyclophosphamide (CTX), total body irradiation (TBI) and cytarabine (Ara-C) or myleran (Bu). Graft-versus-host disease (GVHD) prevention programmes consisted of Cyclosporine (CsA), mycophenolate mofetil (MMF), CD25 monoclonal antibody combined with mesenchymal stem cells (MSC).Twenty six cases of patients were full donor engraftment and 4 cases mixed chimerism into full donor chimerism. The average duration of neutrophil0.5×10⁸/L after NST was 11 (9-16) days, and platelet20×10⁸/L 17 (12-60) days. Upon follow-up of 16 to 120 months, 12-month transplant-related mortality (TRM) was 46.7%, acute Ⅱ-Ⅳgraft-versus-host disease (aGVHD) incidence was 40.0%. The probability of 3-year disease relapse, EFS and overall survival (OS) rates were 16.7%, 46.2% and 50.0% respectively.Haploidentical NST could improve OS and EFS of refractory or relapsed leukemia and reducce TRM to some extent.目的 观察单倍体非清髓造血干细胞移植（NST）治疗难治复发性白血病的疗效及主要并发症。方法 对我中心2000年8月至2009年4月进行单倍体NST治疗的30例难治复发性白血病结果进行分析。其中急性髓系白血病14例,急性淋巴细胞白血病11例,慢性髓性白血病（加速、急变期）5例。预处理方案为氟达拉滨、抗胸腺细胞球蛋白、环磷酰胺、全身照射联合阿糖胞苷或白消安。移植物抗宿主病（GVHD）预防方案为环孢素、霉酚酸酯、CD25单抗联合间充质干细胞。结果 植入情况：30例患者中26例为完全供者嵌合,4例为混合嵌合转变为完全供者嵌合。移植后中性粒细胞＞0.5×109/L恢复平均时间为11（9~16）d,PLT＞20×109/L恢复平均时间为17（12~60）d。平均随访24（16~120）个月,12个月以内移植相关死亡率为46.7%,Ⅱ~Ⅳ度急性GVHD发生率为40.0%,累计3年总的疾病复发率为16.7%,无事件生存率为43.3%,总生存率为50.0%。结论 单倍体NST可以改善难治复发性白血病总生存率和无事件生存率,一定程度上减少移植相关死亡率。