摘要
为进一步探讨慢性粒细胞白血病（ＣＭＬ）的治疗，对３例ＣＭＬ患者采用ＨＬＡ相合同胞兄妹异基因外周血干细胞移植治疗，预处理方案为马法兰（Ｍ）１７０ｍｇ／ｍ２×１，甲环亚硝脲（Ｍ）４００ｍｇ／ｍ２×１，环磷酰胺（Ｃ）６０ｍｇ／ｋｇ×２。供者造血干细胞动员用重组人粒细胞集落刺激因子３００μｇ／ｄ×６，血细胞分离机连续采集外周血单个核细胞，其中ＣＤ３４＋细胞为１２．８～２０．０×１０６／ｋｇ，ＣＦＵ－ＧＭ集落数为３．５～４．３×１０５／ｋｇ。结果显示：移植后患者中性粒细胞恢复达≥０．５×１０９／Ｌ，＋１４～＋２０天；血小板≥２．０×１０９／Ｌ在＋１６～＋３４天。移植后＋１００天骨髓染色体核型分析：２例完全嵌合，Ｐｈ１（－），１例部分嵌合（７３％为供者核型），外周血和骨髓检查正常。结果表明，ＨＬＡ相合同胞兄妹异基因外周血干细胞移植采集方便，重建造血功能快；ＭＭＣ预处理方案对白血病细胞的清除和保证移植物存活均有作用，且移植相关毒性低。
This paper reports 3 cases of allogeneic peripheral blood stem cell transplantation (Allo PBSCT) for the patients with chronic myeloid leukemia (CML). The patients received MMC preparative regimen with high dose chemotherapy (Melphalan 170mg/m 2, po. on Day-5, MeCCNU 400mg/m 2, po.on Day-4, and Cyclophosphomide 60mg/kg/day, iv. on Days-3 and -2). The HLA identical sibling donors received filgrastim (rhG CSF) for mobilization at a dose of 300μg/day for 6 days. Leukaphereses were done at the 6th day of mobilization. A median of 8000ml (2 times total blood volume) of blood was processed the collecting: 2.5 4.5×10 8/kg MNC, 12.8 20.0×10 6/kg CD34 +cells (including 4.8 7.5×10 6/kg CD34 +CD33 -, 8.0 13 0×10 6/kg CD34 +CD33 +), and 3.5 4.3×10 5/kg CFU GM. Cyclosporin A and methotrexate were used for GVHD prophylaxis. Hematopoitic function recovered as for 14-20 days to >0.5×10 9/L of neutrophil count, and for 16-34 days to >20×10 9/L of platelet count. At day +100, chromosome analysis of bone marrow cells showed that complete chimera without ph 1 positive chromosome in Cases 1 and 3, and a partial chimera with 73% donor karyotype in Case 2. All patients now are in disease free survival. No episode of acute graft versus host disease (GVHD) developed. It was concluded that HLA matched sibling allogeneic PBSCT result in rapid hematopoitic reconstitution and the MMC conditioning regimen is effective both in leukemic cells eradication and in immunosuppression for stem cells engraftment, and the drug related toxicity could be tolerated by patients.
出处
《华西医科大学学报》
CSCD
1998年第4期407-410,共4页
Journal of West China University of Medical Sciences
关键词
造血干细胞移植
慢性
粒细胞
白血病
ALLO-PBSCT
Allogeneic peripheral blood stem cell transplantation
Chronic myeloid leukemia
Melphalan
MeCCNU
Cyclophosphomide
