[Decitabine-based Conditioning Regimen Is Feasible and Effective in the Treatment of Myelodysplastic Syndrome and Chronic Myelomonocytic Leukemia]

Zhonghua Xue Ye Xue Za Zhi. 2019 Jun 14;40(6):467-471. doi: 10.3760/cma.j.issn.0253-2727.2019.06.004.
[Article in Chinese]

Abstract

Objective: To assess the efficacy and toxicity of decitabine-based conditioning regimen in patients with myelodysplastic syndrome (MDS) , acute myeloid leukemia secondary to MDS (MDS-AML) or chronic myelomonocytic leukemia (CMML) . Methods: From March 1, 2013 to May 25, 2015, 22 patients who underwent allogenic hematopoietic stem cell transplantation (allo-HSCT) with decitabine-based conditioning regimen were analyzed retrospectively. Results: ①22 patients, 14 males and 8 females with a median age of 42.5 (24-56) years old, were diagnosed as MDS (n=14) , CMML (n=4) , MDS-AML (n=4) . ②15 patients were treated with the conditioning regimen of decitabine combined with busulfan, cyclophosphamide, fludarabine, and cytarabine, the other 7 cases were treated with decitabine, busulfan, fludarabine, and cytarabine. The dose of decitabine was 20 mg·m(-2)·d(-1) for 5 days.Rabbit anti-human anti-thymocyte globulin (2.5 mg·kg(-1)·d(-1) for 4 days) was involved in conditioning regimen in patients with unrelated donor or haploidentical transplantation. ③Except 1 patient died of infection in 2 months after transplantation, the other patients were engrafted successfully. The median time of granulocyte engraftment was 13 (12-18) days, and the median time of platelet engraftment was 16 (13-81) days. ④The incidence of acute graft versus host disease (aGVHD) was (41.3±10.6) %, and severe aGVHD (grade of III-IV) was (18.4±9.7) %. The incidence of chronic graft versus host disease (cGVHD) was (56.4±11.3) %, and extensive cGVHD was (36.4±12.1) %. ⑤8 patients were suffered with cytomegalovirus (CMV) viremia. Among the 18 patients with definitely infection, 6 occurred during myelosuppression and 12 cases occurred after hematopoietic reconstruction. The 2-year and 3-year non-relapse mortality was (13.9±7.4) % and (24.3±9.5) %, respectively. ⑥The 2-year and 3-year overall survival (OS) was (77.3±8.9) % and (67.9±10.0) %, respectively. The 2-year and 3-year relapse-free survival (RFS) was (72.7±9.5) % and (63.6±10.3) %, respectively. Conclusions: allo-HSCT with decitabine-based conditioning regimen is feasible in the treatment of MDS, MDS-AML or CMML.

目的: 探讨含地西他滨预处理方案异基因造血干细胞移植(allo-HSCT)治疗骨髓增生异常综合征(MDS)、MDS转变急性髓系白血病(MDS-AML)及慢性粒-单核细胞白血病(CMML)的疗效及安全性。 方法: 回顾性分析2013年3月1日至2015年5月25日接受包含地西他滨预处理allo-HSCT治疗的22例MDS、CMML、MDS-AML患者的临床资料。 结果: ①全部22例患者中男14例、女8例,中位年龄42.5(24~56)岁;MDS 14例,CMML、MDS-AML各4例。②15例采用地西他滨(20 mg·m(-2)·d(-1)× 5 d)+白消安+环磷酰胺+氟达拉滨+阿糖胞苷预处理方案,7例采用地西他滨+白消安+氟达拉滨+阿糖胞苷预处理方案。无关供者移植、单倍型移植预处理加用兔抗人胸腺细胞免疫球蛋白(ATG)2.5 mg·kg(-1)·d(-1)×4 d。③22例(100%)患者均获得粒细胞植入,中位植入时间为13(12~18)d;21例(95.5%)患者获得血小板植入,中位植入时间为16(13~81)d。④急性GVHD、Ⅲ/Ⅳ度急性GVHD发生率分别为(41.3±10.6)%、(18.4±9.7)%;慢性GVHD、广泛型慢性GVHD发生率分别为(56.4±11.3)%、(36.4±12.1)%。⑤8例发生巨细胞病毒(CMV)血症;18例发生感染,其中6例发生于骨髓抑制期,12例发生于造血重建后;2年、3年非复发死亡率分别为(13.9±7.4)%、(24.3±9.5)%。⑥随访至2018年3月31日,14例患者存活,2年、3年总生存率分别为(77.3±8.9)%、(67.9±10.0)%;2年、3年无复发生存率分别为(72.7±9.5)%、(63.6±10.3)%。 结论: 对于MDS、CMML和MDS-AML患者而言,包含地西他滨预处理allo-HSCT是一种安全可行的治疗方法。.

Keywords: Chronic; Conditioning regimen; Decitabine; Myelodysplastic syndrome.

MeSH terms

  • Adult
  • Busulfan
  • Decitabine
  • Female
  • Graft vs Host Disease*
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Leukemia, Myeloid, Acute*
  • Leukemia, Myelomonocytic, Chronic*
  • Male
  • Middle Aged
  • Myelodysplastic Syndromes*
  • Retrospective Studies
  • Transplantation Conditioning
  • Transplantation, Homologous
  • Young Adult

Substances

  • Decitabine
  • Busulfan