不同移植策略治疗成人急性淋巴细胞白血病的初步观察  

Different transplantation strategies for acute lymphoblastic leukemia in adult patients:Preliminary observations

作　　者：厉新妍[1] 李庆山[1] 王顺清[1] 毛平[1] 

机构地区：[1]广州市第一人民医院血液科,广东省广州市510180

出　　处：《中国组织工程研究与临床康复》2008年第3期477-480,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：广东省医学科研课题(A2007487)~~

摘　　要：目的:对于急性淋巴细胞白血病尤其是Ph+者的造血干细胞移植,为了减少移植后复发,移植时机、移植方案以及移植后的过继免疫治疗至关重要。实验拟观察清髓性与非清髓性移植后供者淋巴细胞输注以及非清髓性移植后采用低剂量环孢素A的效果。方法:选择1998-12/2007-05广州市第一人民医院血液科进行异基因造血干细胞移植的5例成人急性淋巴细胞白血病患者。患者对治疗知情同意,并经医院伦理委员会批准。1例采用传统的白消胺联合环磷酰胺方案做清髓性预处理;4例采用非清髓性造血干细胞移植,其中1例采用以抗胸腺细胞球蛋白为基础减低白消胺联合环磷酰胺强度的预处理,移植后行供者淋巴细胞输注,3例以氟达拉滨为基础的非清髓性移植,采用低剂量环孢素A治疗。移植物抗宿主病的预防均采用短程的甲氨蝶呤联合环孢素A。观察患者治疗后造血、嵌合状态、移植物抗宿主病、感染等移植相关的并发症。结果:所有患者均获得供者细胞的成功植入。①以抗胸腺细胞球蛋白为基础的非清髓性移植获得混合性嵌合体,进行8次淋巴细胞输注后逐渐形成完全供者嵌合体,并发肝脏和皮肤的急性移植物抗宿主病,无病生存。②以氟达拉滨为基础的非清髓性移植获得完全供者嵌合体,1例复发无并发移植物抗宿主病,2例消除BCR/ABL融合基因阳性细胞并发急、慢性移植物抗宿主病。③清髓性移植1例复发、并发急、慢性移植物抗宿主病。结论:①传统的预处理、以抗胸腺细胞球蛋白或者氟达拉滨为基础的非清髓性预处理移植治疗成人急性白血病均可获得供者细胞的成功植入,非清髓性移植后的过继免疫治疗均获得了移植物抗白血病效应。②3种移植策略的疗效、并发症有待进一步观察。AIM： Allogeneic hematopoietic stem cell transplantation for treatment of acute lymphoblastic leukemia characterized with high rate of relapse, especially in Ph^＋ patients. Presently, researchers focus on how to resolve relapse. Transplantation time, transplantation schedule and adoptive immunotherapy after transplantation are important. The study was performed to preliminarily observe treatment effectiveness after myeloablative stem cell transplantation, non-myeloablative transplantation after donor lymphocyte infusion and non-myeloablative transplantation followed by low-doses of Cyclosporin A. METHODS： Five patients were admitted at Department of Haematology of First People＇s Hospital between December 1998 and May 2007. Acute lymphoblastic leukemia patients were informed consent for allogeneic hematopoietic stem cell transplantation. The experiment was approved by hospital ethics committee. Among them, one patient was used the traditional preconditioning of busulfan and cyclophosphamide. Four cases were performed with non-myeloablative hematopoietic stem cell transplantation, and one of them was treated with reduced intensity regimen based on anti-thymocyte globulin donor lymphocyte infusion after transplantation; Three cases with fludarabine-based non-myeloablative transplantation were used low-dose Cyclosporin A after engraftment. Graft-versus-host disease prevention regimen was consisted of short-range methotrexate combined with Cyclosporin A. Haematopoiesis, chimerism, graft-versus-host disease and infection were observed after transplantation. RESULTS： All patients achieved successful＇engraftment. （1）One patient with mixed chimerism received eight donor lymphocyte infusion based on anti-thymocyte globulin-non-myeloablative transplantation and gradually converted into full donor chimerism with disease-free survival, and complicated acute graft-versus-host disease of skin and liver. （2）Three patients achieved full donor chimerism based on fuladarabine-non-myeloablative transplantation, on

关 键 词：急性淋巴细胞白血病 异基因造血干细胞移植 预处理 过继免疫治疗 

分 类 号：R557.4[医药卫生—血液循环系统疾病]