非血缘供者异基因骨髓移植治疗慢性粒细胞白血病  

Allogeneic Unrelated Bone Marrow Transplantation for Chronic Myeloid Leukemia

作　　者：刘霆[1] 贾永前[1] 徐才刚[1] 管利君[1] 牛挺[1] 李英碧[2] 邓长安[1] 

机构地区：[1]华西医科大学附属第一医院血液科,成都 610041 [2]华西医科大学法医学院

出　　处：《华西医科大学学报》2000年第4期533-535,共3页Journal of West China University of Medical Sciences

摘　　要：探讨非血缘供者异基因骨髓移植对慢性粒细胞白血病的治疗 ,并对移植相关并发症作了详细观察和处理。预处理方案为标准 Bu Cy,马利兰 (Bu) 4 mg/(kg· d)× 4;环磷酰胺 (Cy) 6 0 mg/(kg· d)× 2。2例供者均来自台湾慈济骨髓捐赠中心 ,HL A基因配型 (SSOP法 )与患者完全配合。采髓量分别为 12 30 m l和 10 10 ml,其中植入的单个核细胞为 2 .13× 10 8/kg和 2 .38× 10 8/kg;CD34+细胞为 2 .3× 10 6 /kg和 2 .8× 10 6 /kg;CFU- GM4.6× 10 5个 /kg和 5 .3× 10 5个 /kg,BFU- E1.2× 10 5个 /kg和 1.7× 10 5个 /kg,CFU- GEMM3.6× 10 5个 /kg和 4.5× 10 5个 /kg。移植物抗宿主病的预防采用环胞素 A+氨甲蝶呤 +人体丙种球蛋白。结果 :在移植后 + 2 4和 + 16天患者中性粒细胞恢复达≥ 0 .5× 10 9/L,在 + 6 4和 + 45天血小板≥ 2 .0× 10 9/L,+ 30天骨髓染色体核型分析 ,2例均达 90 %以上供者嵌合 ,+ 10 0天达完全嵌合 ,Ph1染色体 (- ) ,血型转变为供者血型 ,DNA可变数目重复序列检测 (VNTR)证实供者源造血重建。结论 :HL A相合非血缘异基因骨髓移植治疗慢性粒细胞白血病获得成功 ,重建了患者造血功能 ;移植相关并发症的及时发现和正确处理是保证移植成功的重要因素。This paper reports 2 cases of allogeneic unrelated bone marrow transplantation for the patients with chronic myeloid leukemia (CML). The patients received standard BuCy preparative regimen〔Busulfan 4mg/(kg·d), po. From Day -7 to Day-4, and Cyclophosphamide 60mg/(kg·day), iv. on Days -3 and -2〕. The donors were from Tzu Chi Marrow Donor Registry, and were HLA well matched with patients based on PCR SSOP. The amounts of bone marrow harvesting were 1230ml and 1010ml respectively, and the engrafts were 2 13 2.38×10 8/kg MNC, 2.3 2.8×10 6/kg CD34 +cells, and 4.6 5.3×10 5/kg CFU GM. Cyclosporin A, methotrexate, and immunoglobulin were used for GVHD prophylaxis. The results showed that hematopoietic function recovered at +24 and +16 days to ≥0.5×10 9/L of neutrophil count, and at +64 and +45 days to ≥20×10 9/L of platelet count. At Day +30, chromosome analysis of bone marrow cells showed over 90% chimera, and at Day +100, a complete chimera with donor karyotype was identified without Ph 1 chromsome. A strong hematopoietic reconstitution was recognized by polymerase chain reaction of variable numbers of tandem repeats (VNTR PCR). In summary, the unrelated donor bone marrow transplantation is effective in curing chronic myeloid leukemia, and it is very important to treat the related morbidity of transplant in time and correctly.

关 键 词：无血缘异基因骨髓移植 慢性粒细胞白血病 CML 

分 类 号：R733.7[医药卫生—肿瘤]