Sustained molecular remission in a patient with CML in blastic crisis receiving dose-reduced hematopoietic stem-cell transplantation followed by early withdrawal of cyclosporine and prophylactic use of interferon-α
Sustained molecular remission in a patient with CML in blastic crisis receiving dose-reduced hematopoietic stem-cell transplantation followed by early withdrawal of cyclosporine and prophylactic use of interferon-α
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DOI：
10.1002/ajh.10203
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发表时间：
2002-11-01
影响因子：
12.8
通讯作者：
Mutou, Y
中科院分区：
文献类型：
--
作者：
Hamaki, T;Kami, M;Mutou, Y
一名 54 岁男性患有急变期慢性粒细胞白血病，接受了来自 HLA 相同的无关供体的减低强度移植 (RIST)。准备方案包括白消安、氟达拉滨和抗胸腺细胞球蛋白。移植物抗宿主病（GVHD）预防仅使用环孢素。由于他复发的风险很高，我们在第 37 天停止使用环孢素，但他没有出现任何急性 GVHD 的迹象。为了诱导 GVHD 并增强移植物抗白血病效应，我们在第 80 天开始使用干扰素 a 治疗，最大剂量为每周 5 次，最大剂量为 300 万单位。他在第 94 天实现了分子缓解，随后出现了广泛的慢性 GVHD，其严重程度与干扰素-a 的剂量相当，GVHD 在停止干扰素-a 后逐渐消退，并且患者在移植后 18 个月仍保持分子缓解。该病例表明，早期停用环孢素并预防性使用干扰素-et 在 RIST 治疗高危白血病中是有希望的。 (C) 2002 Wiley-Liss, Inc.
A 54-year-old man with chronic myelocytic leukemia in blastic phase received reduced-intensity transplantation (RIST) from an HLA-identical unrelated donor. The preparative regimen consisted of busulfan, fludarabine, and anti-thymocyte globulin. Graft-versus-host disease (GVHD) prophylaxis was cyclosporine alone. Because he had a high risk of relapse, we discontinued cyclosporine on day 37, but he did not develop any signs of acute GVHD. To induce GVHD and augment a graft-versus-leukemia effect, we initiated interferon-a therapy on day 80 to a maximum dosage of three million units five times a week. He achieved molecular remission on day 94 followed by the development of extensive chronic GVHD the severity of which paralleled to the dose of interferon-a GVHD gradually subsided after discontinuation of interferon-a and the patient remains in molecular remission 18 months after transplantation. This case suggests that early withdrawal of cyclosporine and the prophylactic use of interferon-et are promising in RIST for high-risk leukemia. (C) 2002 Wiley-Liss, Inc.