| Background:With the development of hematopoietic stem cell transplantation technology,the prognosis of acute leukemia has been greatly improved,but the treatment of relapsed refractory acute leukemia is still a difficult problem.Hematopoietic stem cell transplantation is still the most effective means to cure this disease.The choice of conditioning regimen is one of the key measures for the success of hematopoietic stem cell transplantation in the treatment of acute leukemia.Both as a chemotherapy regimen and a conditioning regimen for hematopoietic stem cell transplantation,chidamide has good effects in clinical application at this stage.purpose:To explore the efficacy of chidamide in the conditioning regimen of allogeneic hematopoietic stem cell transplantation for relapsed/refractory acute leukaemia.Methods:A total of 34 patients diagnosed relapsed/refractory acute leukemia and received allogeneic hematopoietic stem cell transplantation in the First Affiliated Hospital of Harbin Medical University from 2015 to 2020 were selected.Patients were divided into 2 groups: Chidamide combined conditioning regimen group and traditional conditioning regimen group.There were 17 patients in each group.To observe the efficacy of Chidamide,Wilcoxon rank sum test and Fisher exact probability method were used to compare GVHD and other related complications,as well as implantation,recurrence,OS and FPS between the two groups.Patients were follow-up until January 2021.Results:The median age of Chidamide combined conditioning regimen group was 24 years.The median time of neutrophil implantation was d12(10-18)after transplantation,and the median time of platelet implantation was d18(13-28)(There is no statistical difference in implantation time between the control group and the experimental group).One-year OS(overall survival rate)and PFS(progression-free survival rate)were 82.35%,and one patient relapsed.The recurrence rate was 5.88%.The incidence of a GVHD within one year of transplantation was 64.71%,and the incidence of c GVHD was 17.65%;the median age of the control group was 20 years old,and the median time of neutrophil implantation was d13(11-17)after transplantation.The median time of implantation was d17(14-25)after transplantation.The one-year OS and PFS was 76.47%,and the chimerism rate decreased in one patient.2 patients relapsed,the recurrence rate was 11.76%.The incidence of a GVHD within one year of transplantation was 64.71%,and the incidence of c GVHD was17.65%;the main performance of a GVHD were liver(41.17% in the experimental group,35.29% in the control group),gastrointestinal tract(47.06% in the experimental group,29.41% in the control group)),skin(64.71% of the experimental group,52.94% of the control group)damage.There were no statistically significant differences in GVHD,implantation time,OS,and PFS between the two groups(P>0.05).The number of cases of cytomegaloviremia in the experimental group and the control group were 5 and 12,respectively.The cumulative incidences in one year were 29.42% and 70.59%,P=0.0381(P< 0.05).The number of cases of Epstein-Barr Viremia in both groups was 12,with an incidence of 70.59%.8 patients in each group developed hemorrhagic cystitis,with an incidence of 47.06%.The main non-hematological adverse reactions of 34 patients in the two groups were gastrointestinal reactions(nausea,vomiting,gastrointestinal injury),ion disturbances and immunoglobulin deficiency(11 in experiment group and 12 in control group),liver damage(9 in experiment group and control group),hypoproteinemia(9 in experiment group and 7 in control group),implantation syndrome(8 in experiment group and 6 in control group),gradeⅠ-Ⅳmucositis(6 in experiment group and 4 in control group),pneumonia(5 in experiment group and 7 in control group),renal impairment(5 in experiment group and 6 in control group).Conclusions:The chidamide conditioning regimen is effective for patients with relapsed/refractory acute leukemia in the allogeneic hematopoietic stem cell transplantation.Retrospective analysis showed that the incidence of cytomegaloviremia in the chidamide conditioning group was reduced,and the mechanism needs further experimental study. |
