中文摘要：

目的观察和比较血缘与非血缘关系异基因外周血干细胞移植（allo—PBSCT）采用氟达拉滨（Flud）联合白消安（BU）组成的FB减低剂量预处理方案治疗慢性粒细胞白血病（CML）的疗效和移植相关并发症。方法采用FB（Flud30mg·m^2·d^-1×5d；Bu4mg·m^2·d^-1×3d）方案allo—PBSCT治疗CML共44例，接受血缘关系移植29例（血缘组），接受非血缘关系移植15例（非血缘组）。急性移植物抗宿主病（aGVHD）预防：血缘组为霉酚酸酯（MMF）＋环孢素（CsA）＋甲氨蝶呤（MTX），非血缘组在上述基础上另加兔抗人胸腺细胞球蛋白（ATG，5mg／kg×4d）。结果所有患者移植后均取得造血功能重建，血缘组与非血缘组中性粒细胞〉0．5×10^9／L的中位时间分别为13．7（9～18）d和13．6（12～17）d，血小板〉20×10^9／L的中位时间分别为15．3（9～20）d和14．7（10～26）d。但血缘组与非血缘组分别有2例与1例患者移植后5～8个月发生继发性植入排斥，其中血缘组1例再次行同一供体移植，重获造血功能重建。血缘组累计发生aGVHD共4例（13．8％），均为Ⅱ度；存活6个月以上28例患者中发生慢性GVHD（cGVHD）13例（46．4％），其中局限型和广泛型分别为10例和3例。非血缘组累计发生aGVHD共5例（33．3％），其中I～Ⅱ度4例，Ⅲ度1例；存活6个月以上14例患者中发生cGVHD8例（57．1％），其中局限型和广泛型分别为5例和3例。血缘组有2例患者移植后复发，给予冻存G—CSF动员的供者外周血干细胞输注（DSI）1～2次后再获得CR。本组中位随访时间34．7（2～73）个月，累计移植相关死亡10例（22。7％），主要死因是间质性肺炎、GVHD及继发排斥伴重症感染；34例患者存活，预期5年总生存率（OS）和无病生存率（DFS）分别为77．0％和73．9％；其中，血缘关系移植5年OS和DFS分别为79．O％和74．1％，非血缘关系移?

英文摘要：

Objective To evaluate the overall efficacy and transplant-related mortality （TRM） of related and unrelated allogeneie peripheral blood hematopoietic stem cell transplantation （aIIo-PBSCT） in chronic myeloid leukemia （CML） patients conditioned with fludarabine-busulfan（FB） reduced intensity regimen. Methods Forty-four patients received FB（Flud30 mg ·m^2·d^-1×5 d, BU4 mg·m^2·d^-1×3 d ） conditioning followed by allo-PBSCT. Of them, 29 patients were transplanted with related donor and 15 unrelated donor （URD）. All patients received mycophenolate mofetil （MMF）, CsA and MTX for acute GVHD （aGVHD） prophylaxis. 5 ing/kg rabbit-antithymocyte globulin （ ATG-Fresenius ） was incorporated in 15 URD recipients. Results All patients were successfully engrafted. The median times to ANC above 0.5 × 10^9/L in related （RG） and unrelated groups （URG） were 13.7 （9 - 18 ） d and 13.6 （ 12 - 17） d, and PLT above 20 × 10^9/L were 15.3 （9 - 20） d and 14.7 （ 10 - 26） d, respectively. Two patients in RG. 1 in URG developed graft rejection 5 - 8 months after transplantation. One of the two patients in RG received second transplantation and engrafted. The cumulative incidence of aGVHD and cGVHD were 13.8% （4/29） and 46.4% （13/28） in RG, and were 33.3% （5/15） and 57.1% （8/14） in URG respectively. Two patients in RG relapsed after transplantation, and obtained CR again after donor stem cell infusion （DSI）. Median time of follow-up was 34.7 （2 -73 ） months. Thirty-four patients were alive and 10 died. The main causes of death were IP, GVHD, graft rejection and infection. The 5-year overall survival （OS） probability was 77.0% , and the disease-free-survival （DFS） was 73.9% , of which, 79.0% and 74.1% were in RG, and 73.3% and 73.3% in URG, respectively. Conclusions Fludarabine-busulfan based reduced intensity conditioning for allo-PBSCT with either related or unrelated donors is a safe, less toxic and curative approach to CML.