Aplastic Anemia Preconditioned with Fludarabine, Cyclophosphamide, and Anti-Thymocyte Globulin
Aplastic Anemia Preconditioned with Fludarabine, Cyclophosphamide, and Anti-Thymocyte Globulin
复制标题
用氟达拉滨、环磷酰胺和抗胸腺细胞球蛋白预处理再生障碍性贫血。
DOI：
10.12659/aot.915696
复制
发表时间：
2019-08-09
影响因子：
1.1
通讯作者：
Wang, Jianmin
中科院分区：
文献类型：
--
作者：
Yang, Dan;Yang, Jianmin;Wang, Jianmin
背景资料：移植物排斥反应和移植物抗宿主病（GvHD）是严重再生障碍性贫血（SAA）患者造血细胞移植成功的主要障碍。目前还没有足够的数据来确定外周血干细胞移植（PBSCT）在SAA患者，特别是成年SAA患者中的结局。本研究的目的是评价采用FCA方案接受PBSCT的成人SAA患者的结局。FCA方案包括氟达拉滨、环磷酰胺和抗胸腺细胞球蛋白（ATG）。材料/方法：我们报告了46例成人SAA患者接受FCA方案PBSCT的经验。对照组30例，单用环磷酰胺和ATG（CA）方案治疗。并发症和生存结局进行了评估和compared.Results：有一个显着较高的百分比的患者谁达到>95%的供者嵌合体的第30天在FCA组。FCA组的5年无事件生存率（EFS）高于CA组（95.4% vs 73.3%）。此外，FCA组的5年排斥率（RR）低于CA组（4.6% vs 23.6%）。多变量模型将FCA方案确定为影响EFS和RR的独立因素。然而，GvHD和严重感染在两组之间没有差异。对于患者与无关的供体，FCA方案有较高的EFS和较低的RR比CA regiment.Conclusions：FCA方案PBSCT在成人SAA患者相比，有利的CA方案。它可以提高EFS，减少排斥反应，尤其是对非亲缘供者PBSCT。
Background: Graft rejection and graft versus host disease (GvHD) have impeded the success of hematopoietic cell transplantation for severe aplastic anemia (SAA) patients. There is no sufficient data to identify the outcomes of peripheral blood stem cell transplantation (PBSCT) in SAA patients, especially for adult SAA patients. The aim of this study was to evaluate the outcomes of adult SAA patients undergoing PBSCT with the FCA regimen. The FCA regimen includes fludarabine, cyclophosphamide, and anti-thymocyte globulin (ATG).Material/Methods: We report our experience with 46 adult SAA patients who underwent PBSCT with the FCA regimen. Thirty SAA patients who received only cyclophosphamide and ATG (CA) regimen were used as controls. Complications and survival outcomes were evaluated and compared.Results: There was a significantly higher percentage of patients who achieved >95% donor chimerism by day 30 in the FCA group. The 5-year event-free survival (EFS) rate in the FCA group was higher than that in the CA group (95.4% versus 73.3%). In addition, the 5-year rejection rate (RR) in the FCA group was lower than that in the CA group (4.6% versus 23.6%). A multivariable model identified the FCA regimen as an independent factor affecting EFS and RR. However, GvHD and serious infection did not differ between the 2 groups. For patients with an unrelated donor, the FCA regimen had a higher EFS and a lower RR than the CA regimen.Conclusions: The FCA regimen for PBSCT in adult SAA patients compared favorably to the CA regimen. It can improve EFS and reduce graft rejection, especially for unrelated donor PBSCT.