非清髓异基因外周造血干细胞移植治疗难治性恶性血液病  

The clinical research of nonmyeloablative allogenetic peripheral blood hematopoietic stem cell transplantation for refractory hematologic malignacies

作　　者：熊辉霞[1] 陈宝安[1] 丁家华[1] 孙雪梅[2] 赵刚[1] 王骏[1] 高冲[1] 孙耘玉[1] 程坚[1] 董伟民[1] 

机构地区：[1]东南大学附属中大医院血液科,南京210009 [2]南京市鼓楼医院血液科,210008

出　　处：《临床肿瘤学杂志》2005年第1期14-17,共4页Chinese Clinical Oncology

基　　金：江苏省自然科学基金资助项目"免疫细胞性NO供体及白血病体外净化研究"(BK1999126);南京市重大课题基金资助项目"非清髓造血干细胞移植治疗白血病"(Yq0008);东南大学中大医院重大课题资助项目"非清髓造血干细胞移植治疗血液疾病"(2003YJ02)

摘　　要：目的:观察非清髓异基因外周造血干细胞移植(NAST)对难治性恶性血液病的疗效。方法:采用NAST治疗 3例慢性粒细胞白血病加速期(CML -AP)、1例骨髓增生异常综合征(MDS-RAEB T)患者。非清髓预处理方案:氟达拉宾 (Flud)30mg·m-2·d-1×6d,白消安(Bu)4mg·kg-1·d-1×2d,环磷酰胺(CTX)600mg·d-1×2d,3例CML- AP患者在此基 础上加用阿糖胞苷(Ara c)。结果:4例患者造血均顺利恢复,ANC>0.5×109/L平均为12天,BPC>20×109/L平均为11天。 +30天时经短串联重复序列(STR)- PCR检测3例患者为完全嵌合体(CC),1例慢粒患者为混合嵌合体(MC),+90天时全部 患者均处于CC。分别随访4月～16月,均无病存活。结论:非清髓异基因外周造血干细胞移植是治疗CML- AP、MDS -RAEB T 等难治性恶性血液病的有效手段。Objective:To investigate the application of nonmyeloablative allogenetic peripheral blood hematopoietic stem cell transplantation in the treatment of refractory hematologic malignancies.Methods:4 patients received NAST. Of them,3 were chronic myeloid leukemia in accelerated phase(CML-AP),and 1 was myelodysplastic syndrome-refractory anemia with excess blasts in transformation(MDS-RAEB-T).Nonmyeloablative regimens included fludarabine 30mg·m -2·d -1×6d,busulphan 4mg·kg -1·d -1×2d,CTX 600mg·d -1×2d,±Ara-c.Results:All 4 patients were successfully engrafted with donor cells(3 with complete chimerism,1 with mixed chimerism detected by STR-PCR method) on +30d.The median time for neutrophil recovering to >0.5×10 9/L and platelet>20×10 9/L were!12 days and 11 days post-trasnsplant. All patients were alive and disease-free with a median follow-up time of 6(4～16)months.Conclusion:NAST is an effective therapy for patients with CML-AP and MDS-RAEB-T.

关 键 词：患者 非清髓异基因 难治性恶性血液病 外周造血干细胞 移植治疗 CML MDS AP 白消安 混合嵌合体 

分 类 号：R733[医药卫生—肿瘤] R457[医药卫生—临床医学]