异基因外周血造血干细胞移植治疗急性白血病(附1例报告)  

Treatment of one case of adult acute lymphoblastic leukemia withallogeneic peripheral blood stem cell transplantation

作　　者：吴楠[1] 陈嘉榆[1] 黄振倩[1] 巫进明[1] 曹履先[1] 

机构地区：[1]广州市第十二人民医院,广州510620

出　　处：《临床血液学杂志》2004年第5期268-270,共3页Journal of Clinical Hematology

摘　　要：目的 :探索异基因外周血造血干细胞移植 (allo PBSCT)治疗急性白血病的疗效和移植物抗宿主病(GVHD)的防治。方法 :急性淋巴细胞白血病 (ALL )患者 1例 ,HLA配型完全相合。预处理采用白消安、环磷酰胺(BU/CTX )方案 ;GVHD的预防采用常规环胞菌素A(CsA)加短程甲氨蝶呤 (MTX)加霉酚酸酯 (MMF)方案。治疗慢性GVHD(cGVHD)采用MMF加CsA加硫唑嘌呤 (6 mp)加泼尼松加酞咪哌啶酮 (反应停 ,Thalidomide)。移植有核细胞数 (NC)为 12 .32× 10 8/kg ,CD34+ 细胞为 14 .78× 10 6/kg。结果 :移植 +13d获造血重建 ,同时DNA指纹图提示供者型。移植 +2 2d检测染色体核型为 4 6 ,XX ,10 0 %嵌合。移植 +98d血型由B型转变为A型。移植 +2 10d发生cGVHD ,随访 19个月 ,cGVHD已控制 ,患者现无病生存。结论 :异基因外周血造血干细胞移植可有效治疗急性白血病 ,本例造血重建迅速 。Objective:To report a patient with acute lymphoblastic Leukemia (ALL)who was successfully treated to analyze the incidence and the effective prevention and treatment of graft-versus host disease (GVHD) for the allogeneic peripheral blood stem cell transplantation (allo-PBSCT).Method:A 23-year old patient(male) with ALL received allo-PBSCT from a HLA-compatible sibling donor. PBSCT mobilization regimen was G-CSF 250 μg/d×5. The conditioning regimens were BU-CTX. (12.32)×10~8 uncleated cells/kg, (14.78)×10~6 CD34^+ cells/kg were transplanted. The regiment was used for prophylaxis of GVHD which was the combination of low dose cyclosporine (CsA) and short course methotrexate (MTX).chronic GVHD was treated with the combination MMF,CsA,6-MP,prednison and thalidomide.Result:Hematopoietic reconstitution obtained on day 13 after allo-PBSCT. At the same time,the DNA fingerprinting showed engraftment. The chromosome karyotype of recipients in bone marrow and peripheral blood cells showed 100%,46 XX at day 22. The chronic GVHD occurred on day 210 after allo-PBSCT. In the follow-up duration of 19 months, cGVHD was controlled.The patient is still alive in disease free state.Conclusion:Allo-PBSCT was an effective therapy in the treatment of hematological disease,cGVHDwas controlled with effective treatment.

关 键 词：干细胞移植 异基因 白血病 急性 移植物抗宿主病 

分 类 号：R733.71[医药卫生—肿瘤]