无血缘关系供者异基因外周血干细胞移植治疗急、慢性白血病7例  

Unrelated-donor peripheral blood stem cell transplantation for patients with acute/chronic leukemia:An Analysis of 7 cases

作　　者：张曦[1] 陈幸华[1] 高蕾[1] 孔佩艳[1] 刘红[1] 彭贤贵[1] 张诚[1] 高力[1] 王武[1] 孙爱华[1] 王庆余[1] 

机构地区：[1]第三军医大学新桥医院血液科,重庆400037

出　　处：《重庆医学》2007年第22期2292-2294,共3页Chongqing medicine

基　　金：重庆市医学重点学科建设基金(2006C028)。

摘　　要：目的观察无血缘关系供者外周血干细胞移植治疗急、慢性白血病的疗效。方法2005年1月~2006年10月本科行无血缘关系供者造血干细胞移植治疗急、慢性白血病患者7例,所有供受者之间HLA高分辨配型全相合。预处理方案:CY+TBI方案4例、BU/CY方案3例。采用环孢菌素A加骁悉加MTX加ATG(即复宁)预防性控制移植物抗宿主病。结果移植+9^+22d(中位时间+13.2d),中性粒细胞>0.5×109/L;+14^+27d(中位时间+17.5d),血小板>20×109/L。2例于移植+38d和+56d发生Ⅱ度急性移植物抗宿主病,予甲强龙治疗后控制,4例发生慢性移植物抗宿主病,局限型2例,广泛型2例;无1例发生VOD及巨细胞病毒感染;移植相关不良反应CY+TBI方案与BU/CY方案未见差异;随访5~27个月,6例患者无病生存,1例死于本病复发;3例慢性粒细胞白血病bcr/abl融合基因检测转阴。结论无血缘关系供者外周血干细胞移植是一种有效的血液肿瘤治疗方法。Objective To observe the therapeutic effect of unrelated-donor peripheral blood stem cell transplantation （URD-PBSCT） for acute/chronic leukemia. Methods Seven patients with acute/chronic leukemia received HLA completely matched URDPBSCT following conditioning regimens with cyclophosphamide（Cy）/TBI in 4 cases or busulfan（Bu）/Cy in 3 cases and prophylactic preventing graft-versus -host disease （GVHD） with cyclosporine A （CsA）/methotrexate （MTX）/Mycophenolate mofetil （MMF）/ATG （Thymoglobuline） in 7 cases from January 2005 to October 2006. Results The median days for reaching of neutrophil）〉 0.5 × 10^9/L and platelet ）20 × 10^9/L were＋13.2 days （ range＋9- ＋ 22d） and＋ 17.5d （ range＋ 14 - ＋ 27d） respectively after transplantation. Grade Ⅱ acute GVHD had happened in 2 patients and was controlled by prednisolone. Limited and extensive chronic GVHD had happened each in 2 cases. None developed VOD and CMV infection. Transplantation-related side effect was not different between two conditioning regimens. Follow-up period after transplantation was 5--27months, 6 in 7 patients were disease free survival, one patient died of relapse. The fusion gene bcr/abl changed into negative in 3 cases of chronic granulocytic leukemia. Conclusion URD-PBSCT is an effective approach for the treatment of hematological malignancies.

关 键 词：外周血干细胞移植 无血缘关系供者 白血病 移植物抗宿主病 

分 类 号：R733.7[医药卫生—肿瘤] R730.58[医药卫生—临床医学]