| Objective To analyse and evaluate the clinical effects of peripheral blood stem cell transplantation (PBSCT) for patients with myelodysplastic syndrome (MDS).Methods From November 2009 to March 2015,21 patients with MDS accepted PBSCT in the hematopoietic stem cell transplantation (HSCT) center of the First Affiliated Hospital of Chongqing Medical University, including 9 females and 12 males with the median age 48(16-62) years old. According to the latest MDS classification standard (in 2008) from the World Health Organization (WHO), patients were classified as refractory cytopenia with multilineage dysplasia (RCMD, n=2), refractory anemia with excess blasts-1 (RAEB-1, n=8), and RAEB-2 (n=11). According to MDS risk score (in 1997) from the International Prognostic Scoring System (IPSS), patients were divided into intermediate-1 (n=6), intermediate-2 (n=7) and high risk group (n=8). Before transplantation,5 patients developed into secondary acute myelold leukemia (sAML) and 1 patient developed into secondary acute lymphoblastic leukemia (sALL). Before transplantation,12 patients received chemotherapy, in which 8 cases received chemotherapy that contained decitabine and 4 cases received chemotherapy that not contained decitabine. Grouped according to the transplant type,20 patients received allogeneic HSCT (Allo-HSCT) and 1 patient received autologous HSCT (Auto-HSCT). For patients with allo-HSCT, hematopoietic stem cells (HSCs) were mobilized from the donor’s peripheral blood after subcutaneous injection granulocyte-colony stimulating factor (G-CSF) at a dose of 5-10ug/kg·d for 5 days, with apheresis for 2 days. For the patient with auto-HSCT, HSCs were mobilized from the autologous peripheral blood after administering chemotherapy combined with G-CSF to ensure the WBC> 10.0×109/L, with apheresis for 2 days. For patients with allo-HSCT, the Flu+BuCy conditioning regimen was used in 10 cases, and the FLAG+BuCy conditioning regimen was used in 10 cases (in which 2 cases both combined with decitabine), and antithymocyte globulin (ATG) was jointly used for haploid transplantation and unrelated transplantation. For the patient with auto-HSCT, the MAC conditioning regimen was used. The prevention of graft-versus-host disease (GVHD) adopted methotrexate (MTX) and ciclosporin (CsA) combined with mycophenolate mofetil (MMF).Results The haematopoietic system were successfully reconstructed in 19 cases, and the other 2 cases had not obtained hematopoietic reconstitution. The median time of granulocyte lineage reconstructed and megakaryocyte lineage reconstructed was 10.5(8-25)d and 13.5(10-31) d respectively. Three cases developed acute GVHD (aGVHD) and 9 cases developed chronic GVHD (cGVHD). All patients were followed up until March 30,2015. The median follow-up time was 12.8(1.1-60.2) mon.14 cases survived with disease-free, and the other 7 cases were all died, in which 1 case died of recurrence and the other 6 cases died of transplant related complications (TRCs). By Kaplan-Meier method, the 3-year and 5-year overall survival (OS) and disease-free survival (DFS) rates of 21 patients were both (63.5±11.5)% and the estimated mean survival time (MST) was(40.2±6.2) mon. The accumulated relapse rate (RR) was 4.8%, and the transplant-related mortality (TRM) and non-relapse mortality (NRM) rates were both 28.6%.Conclusions PBSCT, especially allo-PBSCT, is an effective method for the treatment of intermediate- and high-risk young patients with MDS, and should be chosen as the the first line therapy and performed as early as possible. |
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