外周血造血干细胞移植治疗恶性血液病53例  

Peripheral Blood Stem Cell Transplantation for 53 Patients with Malignant Hematologic Diseases

作　　者：谢新生[1] 万鼎铭[1] 孙慧[1] 孙玲[1] 刘林湘[1] 姜中兴[1] 

机构地区：[1]郑州大学第一附属医院血液科,河南郑州450052

出　　处：《癌症》2007年第4期403-406,共4页Chinese Journal of Cancer

摘　　要：背景与目的:造血干细胞移植使恶性血液病的预后得到很大的改观,外周血造血干细胞移植(transplantation of peripheral blood stem cells,PBSCT)逐渐取代了骨髓移植(bone marrow transplantation,BMT)而成为造血干细胞移植的主要方式。本研究观察了自体或异基因外周血造血干细胞移植对53例恶性血液病患者的治疗效果。方法:53例恶性血液病患者于2003年7月～2006年5月在郑州大学第一附属医院血液科接受PBSCT治疗,中位年龄37岁。采用G-CSF或化疗联合G-CSF动员外周血干细胞。自体移植患者接受CD34+细胞的中位数为3.0×106/kg,异基因移植患者接受CD34+细胞的中位数为6.2×106/kg;自体移植采用MAC预处理方案,异基因移植采用改良的Bu/Cy预处理方案;移植物抗宿主病(graft versushost disease,GVHD)的预防采用MTX、环孢菌素A联合骁悉,1例1个点不合患者加用抗淋巴细胞球蛋白。结果:移植后中性粒细胞≥0.5×109/L、血小板≥20×109/L的天数在自体移植中分别为13天和19天,在异基因移植中分别为12天和15天;异基因移植中Ⅰ～Ⅲ度急性GVHD(aGVHD)的发生率为31.4%,慢性GVHD(cGVHD)的发生率为71.4%,复发率在自体移植和异基因移植患者中分别为38.9%和5.7%,700天无病生存率在自体移植和异基因移植患者中分别为57.9%和69.5%。结论:自体和异基因外周血造血干细胞移植均能很快地重建造血,是治疗恶性血液病的重要手段之一。BACKGROUND ＆ OBJECTIVE： Hematopoietic stem cell transplantation could improve the progonsis of malignant hematologic diseases. Peripheral blood stem cell transplantation （PBSCT） has been gradually used as an alternative to bone marrow transplantation （BMT）. This study was to observe the efficacy of allogeneic PBSCT （allo-PBSCT） or autologous PBSCT （auto-PBSCT） on malignant hematologic diseases. METHODS： From Jul. 2003 to May 2006, 53 patients with malignant hematologic diseases underwent PBSCT in the First Affiliated Hospital of Zhengzhou University. PBSCs were mobilized with granulocyte colony-stimulating factor （G-CSF） or chemotherapy combined with G-CSF. Auto-PBSCT group received infusion of CD34^＋ cells at a median of 3.0×10^6 cells/kg; allo-PBSCT group received infusion of CD34^＋ cells at a median of 6.2×10^6 cells/kg. MAC regimen was used in auto-PBSCT group as conditioning regimen; amended BU/CY regimen was used in allo-PBSCT group. Methotrexate （MTX） combined with cyclosporine A （CsA） and MMF was used for graft-versus-host disease （GVHD） prophylaxis. Antilymphocyte globulin （ALG） was used in 1 patient with 1 mismatched locus in allo-PBSCT group. RESULTS： The median time for neutrophils to reach 0.5×10^9/L and platelets to reach 20×10^9/L were 13 days and 19 days in auto-PBSCT group, 12 days and 15 days in allo-PBSCT group. In allo-PBSCT group, grade Ⅰ-Ⅲ acute GVHD occurred in 31.4% cases, and chronic GVHD developed in 71.4% cases. The relapse rate was 38.9% in auto-PBSCT group and 5.7% in allo-PBSCT group. The 700-day disease-free survival rate （DFS） was 57.9% in auto-PBSCT group, and 69.5% in allo-PBSCT group. CONCLUSIONS： PBSCT can provide rapid hematopoietic reconstitution. It is a better choice for the cure of malignant hematologic diseases.

关 键 词：血液病 外周血造血干细胞 干细胞移植 重建造血 

分 类 号：R733[医药卫生—肿瘤]