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題 名 | Allogeneic Stem Cell Transplantation for Patients with High-Risk Myelodysplastic Syndrome=以異體幹細胞移植治療高危險之骨髓化生不良症候群病患 |
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作 者 | 許駿; 林敏哲; 唐季祿; 田蕙芬; 王秋華; 陳耀昌; | 書刊名 | 臺灣醫學會雜誌 |
卷 期 | 98:3 1999.03[民88.03] |
頁 次 | 頁157-164 |
分類號 | 415.6 |
關鍵詞 | 異體幹細胞移植; 骨髓化生不良症候群; Myelodysplastic syndrome; Stem cell transplantation; Allogeneic bone marrow transplantation; Graft-versus-host disease; |
語 文 | 英文(English) |
英文摘要 | Allogeneic stem cell transplantation (allo-SCT) is the only treatment with curative potential for patients with myelodysplastic syndrome (MDS). From June 1986 to April 1997, we treated 12 patients with primary MDS (5 men, 7 women, median age, 36.5 years) by allo-SCT. All patients had one or more of the following poor prognostic factors: intermediate-2 or high-risk categories according to the International Prognostic Scoring System; disease progression during follow-up; heavy transfusion requirements and recurrent infections. The median duration from diagnosis of MDS to allo-SCT was 6 months. The preconditioning regimen included total body irradiation combined with either high-dose cytarabine (n=6), high-dose cyclophosphamide (n=4), or other regimens (n=2). Ten patients received bone marrow transplantations and two patients received peripheral blood stem cell transplantations. Prophylaxis for graft-versus-host disease (GVHD) consisted of standard cyclosporin and short-course methotrexate. Acute GVHD of grade 2 or above occurred in 10 patients, while chronic GVHD occurred in seven of the nine patients who survived longer than 6 months after allo-SCT. With a median follow-up of 50 months, all nine patients with human leukocyte antigen (HLA)-matched sibling donors survived. One patient had a relapse 6 months after transplantation and achieved complete remission again with low-dose cytarabine therapy. The three patients receiving allo-SCT from unrelated or HLA-mismatched donors died of grade 3 to 4 acute GVHD and infection within 5 months after transplantation. The estimated disease- free survival at 4 years was 67% (95% confidence interval, 40-93%), and the overall survival was 75% (95% confidence interval, 50-99%). Our data suggest that allo-SCT should be considered early in the clinical course for young MDS patients with a noor prognosis and a matched sibling donor. |
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