中文摘要：

目的 分析两种不同强度预处理方案对系列不明急性白血病（ALAL）异基因造血干细胞移植（allo-HSCT）的疗效.方法 回顾性分析南方医科大学附属南方医院血液内科2002年3月至2010年8月38例ALAL患者临床资料.标准清髓性预处理方案为全身放疗＋环磷酰胺或白消安＋环磷酰胺;超强预处理方案为氟达拉滨＋阿糖胞苷＋全身放疗＋环磷酰胺.移植物抗宿主病（GVHD）预防在人白细胞抗原（HLA）全相合相关移植患者用环孢素A（CsA）＋甲氨蝶呤（MTX）,HLA不相合相关移植及无关移植患者采用CsA＋MTX＋抗胸腺细胞球蛋白和（或）霉酚酸酯.COX模型分析影响长生存的因素.结果 19例患者接受标准预处理方案;19例接受超强预处理方案.移植后38例患者均获造血重建,5年累计总体总生存（OS）和无病生存（DFS）率分别为35.5%和25.7%;标准预处理组和超强预处理组5年0s率分别为20.2%与48.1%（P=0.233）、DFS为6.5%与43.1%（P：0.031）.38例患者移植后5年白血病累计复发率为58.9%,标准预处理组和超强预处理组分别为87.6%和30.4%（P=0.003）.COX单因素分析显示：超强预处理及慢性GVHD为DFS的保护因素（P=0.001、0.031）.结论 在allo-HSCT中应用超强预处理能改善ALAL患者的生存及减少复发,移植物抗白血病效应对ALAL患者具有一定疗效.

英文摘要：

objective To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation （allo-HSCT）in the conditionings of different intensities for acute leukemias of ambiguous lineage（ALJAL）. Methods A total of 38 ALAL patients were treated with two conditionings of different intensities in our hospital from March 2002 to August 2010. The standard conditioning included TBI＋Cy or Bu＋Cy,intensified conditioning included Fludarabine＋Ara-C＋TBI＋Cy. Cyelosporine A（CsA）and methotrexate （MTX） were administered in patients with human leukocyte antigen-matched sibling donor. And CsA, MTXplus antihuman thymocyte globulin and/or mycophenolate were used in all patients with HLA-A-mismatched related donor and unrelated donors transplants for graft-versus-host disease（GVHD）prophylaxis. COX regression was used to evaluate the prognostic factors of ALAL Results Among 38 ALAL patients,19received the standard conditioning while another 19 the intensified conditioning. All patients achieved hematopoietic reconstitution. The 5-year overall survival（OS）and the disease-free survival（DFS）were 35. 5%and25. 7%respectivelv. The 5-year OS rates were 20. 2%and48. 1%（P=0. 233）and DFS 6. 5%and 43. 1%（P=0. 031）in the standard and intensified conditioning groups respectively. The 5-year cumulative relapsing incidence was 58. 9%in all patients and 87. 6% vs 30. 4% in the standard and intensifted conditioning groups respectively（P=0. 003）. Through a COX regression model for univariate analysis, the intensified conditioning and chronic GVHD were protective factors for DFS （P = 0. 001,0. 031 ）. Conclusions The intensified conditioning in ALAL patients undergoing allo-HSCT may improve the long-term patient survival and decrease the relapse of leukemia. The graft versus leukemic effect has some efficacy in ALAL patients undergoing allo-HSCT.