Fludarabine and cytarabine combined chemotherapy followed by transfusion of donor blood stem cells for treating relapse of acute leukaemia after allogeneic haematopoietic stem cell transplantation

作     者：YOU Yong LI Qiu-bai CHEN Zhi-chao LI Wei-ming XIA Ling-hui ZHOU Hao ZOU Ping 

作者机构：Institute of Haematology Union Hospital Tongji Medical College of Huazhong University of Science and Technology WuhanHubei 430022 China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2008年第121卷第18期

页      面：1770-1774页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：Key Project Fund of Hubei Bureau of Health [JX2A10] 

主　　题：fludarabine allogeneic haematopoietic stem cell transplantation relapse acute leukaemia 

摘      要：Background Relapse remains an obstacle to successful allogeneic haematopoietic stem cell transplantation （allo-HSCT） for patients with acute leukaemia and no standard treatment is available. We assessed fludarabine and cytarabine with transfusion of donor haematopoietic stem cell in treating the relapse of acute leukaemia after allo-HSCT. Methods Seven patients, median age 34 years, with relapse of acute leukaemia after allo-HSCT received combination chemotherapy of fludarabine with cytarabine for 5 days. Five patients suffered from acute myeloid leukaemia （2 refractory） and 2 refractory acute lymphoblastic leukaemia. After the transplantation, the median relapse time was 110 days （range, 38-185 days）. Two days after chemotherapy, 5 patients received infusion of donor＇s peripheral blood stem cells, mobilized by granulocyte colony stimulating factor. No prophylactic agents of graft versus host diseases were administered, Results Six patients achieved haematopoietic reconstitution. DNA sequence analysis at day 30 after treatment identified all as full donor chimera type. The median observation time was 189 days. After the treatment, the median time for neutrophilic granulocyte value 〉0.5×10^9/L and for platelet value 〉20×10^9/L were 13 days （range, 10-18 days） and 15 days （range, 11-24 days）, respectively. Graft versus host disease occurred in 2 patients （acute） and 3 （chronic）. Five patients suffered from pulmonary fungal infection （2 died）, 3 haemorrhagic cystitis and 2 cytomegalovirus viraemia. The other patients died of leukaemia related deaths. Three patients with chronic graft versus host disease who had received donor peripheral blood stem cells reinfusion have survived for 375 days, 232 days and 195 days, respectively. Conclusions Fludarabine with cytarabine plus the donor haematopoietic stem cell should be considered as an effective therapeutic regimen for relapse of acute leukaemia after alIo-HSCT. The disease free state of patients may increase, though with