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作 者:张荣艳[1] 陈艳 李菲[1] 陈国安[1] 杨赣萍[1] 冯嗣青[1] 黄瑞滨[1] 黄先豹[1]
机构地区:[1]南昌大学第一附属医院血液科,南昌330006
出 处:《江西医学院学报》2006年第5期61-63,66,共4页Acta Academiae Medicinae Jiangxi
摘 要:目的探讨不含全身照射(TBI)预处理方案异基因外周血干细胞移植(allo-PBSCT)治疗恶性血液病的临床疗效及并发症的防治。方法总结19例急、慢性髓系白血病和1例系统性红斑狼疮(SLE)并Sezary综合征患者经allo-PBSCT治疗的临床资料。20例的供者均为HLA-Ⅰ/Ⅱ抗原完全相合的同胞,采用不含TBI改良Bu/Cy预处理方案即马利兰(Bu)+阿糖胞苷(Arac)+环磷酰胺(CTX)+甲基环己亚硝脲(Me-CCNU)及减低剂量Bu+Arac+CTX+氟达拉滨(Flu)。所有病人均采用环胞菌素A和短程MTX进行GVHD的预防。结果20例患者allo-PBSCT后均获得造血重建,移植后中性粒细胞恢复至≥0.5×10^9/L平均时间为13d,血小板恢复至≥20×10^9/L平均时间为14d。20例患者中未发生急性GVHD,25%出现慢性GVHD4出血性膀胱炎发生率10%;所有患者均未发生肝静脉闭塞综合征(HVOD)及间质性肺炎。中位随访时间19.6(3~66)月,18例仍无白血病生存,1例移植后3年继发胃癌死亡,1例急性淋巴细胞白血病移植后半年复发,最长无病生存期达5.6年。结论不含TBI改良的Bu/Cy预处理方案为CML和AML的有效方案,它具有白血病复发率低,植活率高及疗效满意,毒副反应相对较少,不需高级放疗设备且实施方便等优点。但作为ALL的预处理方案则有待于进一步证实。Objective To evaluate the clinical effect of allogeneic peripheral blood stem cell transplantation (allo-PBSCT) by non-intradiation treatment on malignant hematopoietic diseases. Methods 19 patients with acute and chronic leukemia and 1 with SLE combined with Sezary Syndrome underwent allo-PBSCT from HLA-identical siblings. The conditioning regimen consisted of the high dose combination chemotherapy Busulfan(Bu )+ Cytarabine(Ara-c)+ cyclophosphamide(CTX)) + Me-CCNU and a decreased dose combination chemotherapy:Bu + Ara-c+ CTX +Fludarabine(Flu)o Cyclosporine-A(CsA) plus a short course of MTX was used for GVHD prophylaxis in the patients. Results After transplantation , median time for the recovery of granuocyte ≥0.5 × 10^9/ L and platelets ≥20 ×10^9/ L were 13 (11~18) and 14 (13~25) days, Of 20 cases, 5 developed chronic GVHD. All of 20 survivals did not show HVOD and insterstitial pneumonia (IP). After follow-up for 19.6 (3~66)months, 18 patients were still disease-free survival, 1 patient who died of gastric cancer in 3 year after transplant. One patient relapsed. Conclusion Non TBI as conditioning regimen is effective for patients with CML and AML, relatively easy to administer, with low extramedullary toxicities. However, it is not effective enough for patients with All.
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