双次自体造血干细胞移植治疗成人急性淋巴细胞白血病疗效观察  

Clinical efficacy of double autologous hematopoietic stem cell transplantation in the treatment of adult acute lymphoblastic leukemia

作　　者：黄文荣[1] 张伯龙[1] 姚善谦[1] 高春记[1] 吴晓雄[1] 张苗[1] 张战强[1] 靳海杰[1] 达万明[1] 汪月增[1] 

机构地区：[1]解放军总医院,北京100853

出　　处：《中华血液学杂志》2001年第8期399-402,共4页Chinese Journal of Hematology

摘　　要：目的　评价双次自体造血干细胞移植 (DAHSCT)治疗急性淋巴细胞白血病 (ALL)的临床疗效及部分影响因素。方法　 13例成人ALL患者获完全缓解 (CR) 12个月内行第 1次自体造血干细胞移植 ,以足叶乙甙 (Vp16 )总量 6 0 0～ 10 0 0mg[或阿糖胞苷 (Ara C) 2～ 4g/m2 ]+环磷酰胺 (CTX) 12 0mg/kg+分次全身照射 (TBI) 7.5～ 9.0Gy进行予处理 ,其中 6例一次性加用总量 12 5mg的卡氮芥 (BCNU) ;第1次自体造血干细胞移植术后 4～ 10个月进行第 2次自体造血干细胞移植 ,预处理方案为Vp16总量6 0 0～ 10 0 0mg(或Ara C 2～ 4g/m2 ) +马法兰 (Mel) 140mg/m2 +CTX 12 0mg/kg。结果　所有患者两次移植后均获造血重建 ,无一例移植相关死亡。中位随访时间 837(5 34～ 2 0 99)d ,存活 7例 (5 3.8% ) ,DAHSCT后 3年无病生存率 (5 3.8± 7.7) % ,复发死亡 6例 (4 6 .2 % ) ,第 2次移植时骨髓原始、幼稚淋巴细胞比例高于第 1次移植时 ,患者易于复发。结论　DAHSCT移植相关死亡率低 ,无病生存率较高 。Objective To evaluate the clinical efficacy of double autologous hematopoietic stem cell transplantation (DAHSCT) in adult acute lymphoblastic leukemia and analyse the affecting factors. Methods Thirteen adult acute lymphoblastic leukemia (ALL) patients received the first AHSCT in 12 months after complete remission (CR). The first conditioning regimen was Vp16 600～1000mg or Ara C 2～4 g/m 2,CTX 120 mg/kg,total body irradiation(TBI) 7.5～9.0?Gy and in 6 patients BCNU 125mg was added. All the patients received the second AHSCT in 4 to 10 months after the first AHSCT. The second conditioning regimen was Vp16 600～1000mg or Ara C 2～4g/m 2,Mel 140 mg/m 2,CTX 120 mg/kg. Results All engrafted patients had rapid hematopoietic reconstitution. There was no AHSCT related death. The median follow up duration was 837 days. Seven of the 13 DAHSCT patients were alive. The 3 year disease free survival (DFS) was (53.8±7.7)%. Those who had more lymphoblasts in bone marrow at the second AHSCT than that at the first AHSCT had greater probability of relapse. Conclusion It suggested that DAHSCT could be used as an important treatment owing to its low AHSCT related death and relatively long DFS.

关 键 词：急性淋巴细胞白血病 治疗 双次自体造血干细胞移植 疗效观察 

分 类 号：R733.7[医药卫生—肿瘤] R457.7[医药卫生—临床医学]