Second marrow transplants in patients with aplastic anemia rejecting the first graft: use of a conditioning regimen including cyclophosphamide and antithymocyte globulin.
Second marrow transplants in patients with aplastic anemia rejecting the first graft: use of a conditioning regimen including cyclophosphamide and antithymocyte globulin.
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DOI：
10.1182/blood.v70.1.116.116
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发表时间：
1987-07
期刊：
影响因子：
20.3
通讯作者：
R. Storb;Weiden Pl;K. Sullivan;Appelbaum Fr;P. Beatty;Buckner Cd;R. Clift;K. Doney;J. Hansen;P. Martin
中科院分区：
文献类型：
--
作者：
R. Storb;Weiden Pl;K. Sullivan;Appelbaum Fr;P. Beatty;Buckner Cd;R. Clift;K. Doney;J. Hansen;P. Martin
在146例准备用环磷酰胺(200 mg/kg)植入的重型再生障碍性贫血患者中，有16例(11%)排斥他们的人类白细胞抗原相合的同胞的骨髓移植。他们在第一次移植后23天至743天(中位数86天)接受了第二次骨髓移植，来自相同(n=13)或第二(n=3)个人类白细胞抗原相合的兄弟姐妹。第二次移植的准备包括环磷酰胺，50 mg/kg，连续4天，每天一次。前3次注射环磷酰胺12h后，给予抗胸腺细胞球蛋白30 mg/kg/剂量。在16例患者中，1例在第二次移植后过早死于感染，有待评估，2例植入失败，死于感染，1例拒绝第二次移植，并在近5年后存活，完全自体骨髓恢复，12例成功并持续第二次移植。在这12例中，有6例存活时间在11个月至7 3/4年之间。六人中有四人没有移植物抗宿主病(GVHD)，两人患有需要治疗的慢性GVHD。其中5人的卡诺夫斯基评分为100%，1人的卡诺夫斯基评分为90%。在12名持续移植的患者中，有6人在移植后63天至38个月内死亡，4人感染(两名患者与慢性GVHD有关)，1人急性GVHD，1人出血。在过去的五年中，从第一次移植到第二次移植的平均间隔为308天，而早期患者为61天。最近的七名患者中有五名存活下来，而早期的九名患者中有两名幸存下来。综上所述，在大多数排斥第一次骨髓移植的再生障碍性贫血患者中，继环磷酰胺和抗胸腺细胞球蛋白之后的第二次移植是可能成功的；然而，死亡率仍然很高，只有40%的患者成为长期存活者。
Sixteen (11%) of 146 consecutive patients with severe aplastic anemia prepared for engraftment with cyclophosphamide (200 mg/kg) rejected marrow grafts from their HLA-identical siblings. They were given a second marrow transplant from either the same (n = 13) or a second (n = 3) HLA-identical sibling between 23 and 743 (median 86) days after the first transplant. The preparation for the second transplant included cyclophosphamide, 50 mg/kg, on each of four successive days. Twelve hours after each of the first three doses of cyclophosphamide, antithymocyte globulin, 30 mg/kg/dose, was infused. One of the 16 patients died from infection too early after the second transplant to be evaluated, two had failure of engraftment and died with infection, one rejected the second graft and is surviving almost 5 years later with full autologous marrow recovery, and 12 had successful and sustained second grafts. Of these 12, six are surviving between 11 months and 7 3/4 years. Four of the six have no graft-v-host disease (GVHD), while two have chronic GVHD requiring treatment. Five have Karnofsky scores of 100% and one of 90%. Six of the 12 patients with sustained grafts died between 63 days and 38 months after transplantation, four with infections (related in two patients to chronic GVHD), one with acute GVHD, and one with hemorrhage. The average interval from first to second transplant was 308 days during the past five years, compared to 61 days in earlier patients. Five of seven recent patients are surviving, compared to two of nine earlier patients. In conclusion, successful second transplants after cyclophosphamide and antithymocyte globulin are possible in most patients with aplastic anemia who have rejected their first marrow grafts; however, mortality remains high, with only 40% of the patients becoming long-term survivors.