摘要
目的观察不同来源的异基因造血干细胞移植治疗白血病的疗效并探讨主要并发症的处理方案。方法对2001年9月至2007年3月第四军医大学西京医院血液科76例白血病患者行异基因造血干细胞移植治疗，其中慢性粒细胞白血病34例，急性髓性白血病24例，急性淋巴细胞白血病15例，T细胞淋巴瘤／白血病3例。人类白细胞抗原（HLA）全相合的同胞供者57例，1个HLA位点不合同胞供者3例，HLA单倍型半相合同胞供者7例，非血缘供者9例。预处理方案采用改良的马利兰联合环磷酰胺（BUCY）或改良的环磷酰胺联合全身放疗及阿糖胞苷或鬼臼乙叉甙（CyTBI＋Ara-c／VP-16）方案。采用标准的环孢素A（CsA）联合短期甲氨蝶呤（MTX）方案预防移植物抗宿主病（GVHD）；无关供者移植加用抗人胸腺细胞球蛋白，单倍型半相舍移植同时加用CD25单克隆抗体。结果96.1％（73／76）获得植入。24.7％（18／73）出现急性GYHD，32.9％（24／73）出现慢性GVHD；合并重症肝静脉闭塞病2例；并发纯红细胞性再生障碍性贫血5例。随访3～72个月，现存活56.6％（43／76），43.4％（33／76）在移植后1～36个月时死亡，19例死于白血病复发，14例死于移植相关并发症。结论多种来源的异基因造血干细胞移植是治疗白血病的有效方法，于慢性粒细胞白血病慢性期、急性白血病缓解期移植效果较好，移植前处于高危难治状态的病例复发率仍较高。
Objective To observe the efficacy and main complications of allogeneic hematopoietic stem cell transplantation （allo-HSCT）for 76 patients with hematopoietic malignancies. Methods From September 2001 to March 2007,76 patients received allo-HSCT in Department of Hematology, Xijing Hospital, Fourth Military Medical University. All cases in-cluded 24 acute myeloid leukemia（ AML）, 15 acute lymphocytic leukemia（ALL） and 34 chronic myelogenous leukemia （CML） and 3 T cell lymphoma/leukemia. Donors were HLA-identical sibling（n=57）, 1 locus mismatched sibling（n=3）, HLA-matched unrelated volunteer（n=9） and haplo-identical sibling（n=7 ）. Conditioning regimen consisted of busul-phan-cyclophosphanfide or cyclophosphamide and total body irradiation plus Ara-c/VP-16. Graft versus-host disease prophylaxis was the standard methotrexate and cyclosporine combination. Anti-human thymocyte immunoglobulin （ATG） and CD25 monoclonal antibody was given in unrelated donor and haplo-identical HSCT. Results Totally 73 patients got sustained engraftment. Acute GVHD and chronic GVHD were found in 18/73 （24.7% ） and 24/73 （32.9% ） patients, re spectively. Severe veno-occlusive disease occurred in 2 cases. Pure red cell aplasia was found in 5 patients with major ABO mismatched HSCT. With a follow-up of 3 to 76 months, 43/76 （ 56. 6% ） ） patients were still alive and 33/76 （43.4%） died from leukemia relapse or transplantation-related complications. Conclusion Allogeneic heamatopoietic stem cell transplantation is an effective therapy for leukemia, especially in CML-chronic period and acute leukemia in complete remission ,but there is high rate of relapse in patients with high-risk and refractory status before transplantation.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2007年第20期1616-1618,共3页
Chinese Journal of Practical Internal Medicine
关键词
造血干细胞移植
异基因
白血病
Heamatopoietic stem cell transplantation
Allogeneic
Leukemia
