异基因外周血造血干细胞移植治疗白血病(附 50例临床报告)(英文)  

Allogeneic peripheral blood stem cell transplantation in treatmemt of leukemia: A report of 50 cases

作　　者：王健民[1] 章卫平[1] 宋献民[1] 楼敬伟[1] 童书鹏[1] 杨建民[1] 闵碧荷[1] 李红梅[1] 丁晓勤[1] 钱宝华[1] 肖作平[1] 

机构地区：[1]第二军医大学长海医院血液科,上海200433

出　　处：《第二军医大学学报》2002年第9期933-938,共6页Academic Journal of Second Military Medical University

基　　金：National Natu-ral Science Foundation of China( No.39370 32 1) and the"HundredL eading Physician Program" of the Public Health Sector of ShanghaiMunicipal Government( No.98BR0 2 9) to JW

摘　　要：目的 :评价异基因外周血造血干细胞移植 (Allo- PBSCT)治疗白血病的疗效 ,同时比较 ABO血型相合与不相合移植以及两种移植物抗宿主病 (GVHD)预防方案。方法 :用 Allo- PBSCT治疗白血病 5 0例 (急性 2 9例 ,慢性 2 1例 ) ,其中 ABO血型相合 30例 ,不相合 2 0例。 PBSC动员采用 G- CSF或 G- CSF+GM- CSF皮下注射 5 d;预处理采用 CTX+VP16 +TBI或CTX+TBI方案 ;GVHD预防采用常规环孢素 A(Cs A) +短程甲氨蝶呤 (MTX)和霉酚酸酯 (MMF)联合 Cs A +短程 MTX两种方案。 结果 :本组患者经 Allo- PBSCT均获得造血功能重建。 ABO血型相合移植与不相合移植比较 ,后者血红蛋白恢复较慢 (P<0 .0 5 ) ,中性粒细胞和血小板恢复两者无差异 (P>0 .0 5 )。本组发生 a GVHD 2 0例 (4 0 %) ,其中 度以上 9例 (18%)。生存 6个月以上者发生 c GVHD 2 2例 (6 6 .6 7%) ,其中广泛性 11例 (33.33%)。 MMF联合 Cs A和 MTX方案与常规 Cs A联合MTX方案相比 ,前者可减少 a GVHD发生率 (P<0 .0 5 ) ,虽两者 c GVHD总发生率无差异 (P>0 .0 5 ) ,但前者广泛性 c GVHD明显减少 (P<0 .0 5 ) ;本组患者中位随访 30个月存活 33例 ,移植后 3年无病生存率为 6 6 %;GVHD合并感染和间质性肺炎是主要死因。结论 :ABO血型不合不影响移植 。Objective:To evaluate the efficacy of allogeneic peripheral blood stem cell transplantation (Allo-PBSCT) in the treatmemt of leukemia.Methods: Twenty-nine patients with acute leukemia and 21 patients with chronic leukemia were treated with Allo-PBSCT. ABO blood types were matched in 30 patients and mismatched in 20 patients. PBSC were mobilized with G-CSF or G-CSF+GM-CSF for 5 d. Conditioning regimens included standard TBI plus CTX or TBI plus CTX and VP16. Two regimens were used for prophylaxis of graft-versus-host disease (GVHD), one was the traditional combination of low dose cyclosporine(CsA) and short course methotrexate(MTX)(CsA/MTX group), the other was short course mycophenolate mofetil(MMF)besides CsA and MTX(MMF/CsA/MTX group). Results: All patients were successfully engrafted. Hemoglobin recovery (to 80 g/L) was significantly slower in ABO mismatched patients (median 52 d) than matched patients (median 14 d)(P<0.05), and there was no significant difference in the recovery of granulocyte and platelet (P>0.05). The incidence of aGVHD was 40% (20/50) with grade Ⅱ-Ⅳ 18%(9/50). cGVHD occurred in 22 of 33 patients (66.67%) lived longer than 6 months post-transplantation, and 11 of them were with extensive cGVHD (33.33%). The incidence of aGVHD in MMF/CsA/MTX group (16.67%) was significantly lower than that of CsA/MTX group (53.13%)(P<0.05). Although the incidence of cGVHD was the same in 2 groups (P>0.05), the incidence of extensive cGVHD was lower in MMF/CsA/MTX group (9.09%) than that of CsA/MTX group (45.45%) (P<0.05).The median follow-up period was 30 months. The 3 year disease-free-survival (DFS) was 66%. GVHD, infection and interstitial pneumonitis were the main causes of death. Conclusion: Allo-PBSCT is a safe and effective therapy for leukemia. The MMF/CsA/MTX regimen for prevention of aGVHD is more efficient than CsA/MTX.

关 键 词：外周血 造血干细胞移植 异基因 白血病 移植物抗宿主病 治疗 

分 类 号：R733.705[医药卫生—肿瘤]