单次与两次自体造血干细胞移植治疗血液肿瘤的远期结局比较:150例资料回顾  

Long-term outcome comparison between single and double autologous hematopoietic stem cell transplantation for hematologic malignancies:Data review in 150 cases

作　　者：靖彧[1] 于力[1] 刘海川[1] 姚善谦[1] 楼方定[1] 周绮[1] 李红华[1] 薄剑[1] 王全顺[1] 赵瑜[1] 朱海燕[1] 

机构地区：[1]解放军总医院血液科,北京市100853

出　　处：《中国组织工程研究与临床康复》2007年第42期8501-8505,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:对没有与供者HLA配型相合的血液恶性肿瘤患者来说,自体造血干细胞移植不失为一种积极有效的治疗方法。评价比较单次与两次自体造血干细胞移植治疗血液肿瘤的效果。方法:①实验对象:选取1988～2001年解放军总医院血液科行自体造血干细胞移植的150例患者,对本实验均知情同意。其中两次自体移植25例(两次骨髓移植3例、两次外周血造血干细胞移植1例、1次骨髓移植+1次外周血造血干细胞移植21例),单次自体移植125例(骨髓移植44例、外周血造血干细胞移植81例);急性非淋巴细胞白血病75例,急性淋巴细胞白血病43例,非霍奇金淋巴瘤22例,霍奇金淋巴瘤10例。②实验方法:应用化疗使白血病患者在移植前达到完全缓解,淋巴瘤患者要求移植前至少骨髓中没有肿瘤累及。动员化疗方案原则上采用对相应肿瘤有效的联合化疗方案,并适当增加剂量。骨髓移植及外周血造血干细胞移植患者回输单核细胞中位数分别为2.68×108/kg,4.20×108/kg。115例患者采用环磷酰胺/全身放疗方案,35例患者采用不含全身放疗的高剂量化疗方案。③实验评估:自体造血干细胞移植5年后血液肿瘤患者的无病存活率。结果:①急性非淋巴细胞白血病:69例患者单次移植,5年无病存活率58.0%(40例),复发率29.0%(20例),移植相关死亡率13.0%(9例)。6例患者两次移植,其中1例M5患者复发死亡,5例无病存活。②急性淋巴细胞白血病:29例患者单次移植,5年无病存活率34.5%(10例),复发率34.5%(10例),移植相关死亡率31.0%(9例)。14例患者两次移植,5年无病存活率42.9%。③非霍奇金淋巴瘤:18例患者单次移植,5年无病存活率61.1%(11例),复发率16.7%(3例),移植相关死亡率22.2%(4例)。4例患者两次移植,其中1例CR1期患者在首次移植后21个月复发,化疗获得PR后行第2次自体造血干细胞移植,17个月后复发死亡;其余3例均无病存活。④霍奇AIM： As to the patients with hematologic malignancies, who are not donor HLA matched, autologous hematopoietic stem cells transplantation （AHSCT） provides an effective treatment approach. In this study, the effect of single and double AHSCT on the treatment of hematologic malignancies was evaluated and compared. METHODS： （1）150 patients with hematologic malignancies, who received AHSCT at the Department of Hematology, General Hospital of Chinese PLA from 1998 to 2001, were selected as subjects with the informed consent. Of them, 25 cases received double-AHSCT （3 cases for double bone marrow transplantations, 1 for double peripheral hematopoietic stem cell transplantations, 21 for once bone marrow transplantation and once peripheral hematopoietic stem cell transplantation） and 125 cases received single-AHSCT in the same period （44 cases for bone marrow transplantation, and 81 for peripheral hematopoietic stem cell transplantation）. There were 75 patients with acute myelogenous leukemia （AML）, 43 with acute lymphocytic leukemia （ALL）, 22 with non-Hodgkin＇s lymphoma （NHL）, and 10 with Hodgkin＇s disease （HD）, respectively. （2）The leukaemia patients were treated by chemotherapy for complete remission before transplantation. And the patients with lymphoma should have no tumor involved in bone marrow before transplantation. Chemotherapy regimens were composed of effective united chemotherapy to relevant tumors and the increased doses. The median of transfusion mononuclear cells （MNC） for patients of bone marrow transplantation and peripheral hematopoietic stem cell transplantation was 2.68 ×10^8/kg and 4.20 ×10^8/kg, respectively. 115 patients received cyclophosphamide and total body irradiation （TBI） for preparative regimen. Thirty-five patients received high dose chemotherapy without TBI for preparative regimen. （3） Disease-free survival rate for patients with hematologic malignancies in 5 years post AHSCT was evaluated. RESULTS： （1）AML： For 69 single-A

关 键 词：造血干细胞移植 自体 血液肿瘤 5年无病存活率 

分 类 号：R394.2[医药卫生—医学遗传学]