无血缘关系供体外周血造血干细胞移植治疗白血病的临床研究  

Unrelated-donor peripheral blood stem cell transplantation for patients with leukemia

作　　者：宋献民[1] 王健民[1] 侯军[1] 杨均仪 杨颖[3] 丁晓勤[1] 龚胜蓝[1] 

机构地区：[1]第二军医大学长海医院血液科,上海200433 [2]上海市红十字会 [3]上海市血液中心遗传室

出　　处：《第二军医大学学报》2002年第9期943-945,共3页Academic Journal of Second Military Medical University

基　　金：上海市卫生系统百名跨世纪优秀学科带头人培养计划资助项目 (98BR0 2 9)

摘　　要：目的 :观察无血缘关系供体外周血造血干细胞移植 (PBSCT)治疗白血病的疗效及其并发症的防治。 方法 :用 HL A配型完全相合的无关供体移植治疗白血病 3例。预处理方案为 :例 1采用环磷酰胺 (CTX) +全身照射 (TBI) ;例 2采用 CTX+TBI+抗胸腺细胞球蛋白 (ATG) ;例 3采用 CTX+TBI+ATG+依托泊苷 (VP16 )。 3例患者输入单个核细胞数 (/ kg)分别为5 .90× 10 8、6 .43× 10 8和 6 .0 1× 10 8,CD34 +细胞 (/ kg)分别为 6 .34× 10 6、2 .6 2× 10 6和 2 .30× 10 6;急性移植物抗宿主病(GVHD)预防采用霉酚酸酯 (MMF)联合环孢素 A (Cs A)和短程甲氨蝶呤 (MTX)方案。 结果 :3例患者均顺利造血重建 ,无 1例发生 度或 度以上急性 GVHD;例 1患者移植后 180 d细胞遗传学复发 ,停用 Cs A后 2个月 Ph染色体消失 ,且出现局限性慢性 GVHD;例 2患者移植后 2 2 0 d出现局限性慢性 GVHD;例 3患者移植后 30 0 d有复发趋势 ,停用 Cs A 2周后完全缓解。结论 :无关供体 PBSCT可用于治疗白血病 ;MMF联合 Cs A和短程 MTX可用于预防无关供体移植急性 GVHD的发生。Objective:To observe the effect of unrelated-donor peripheral blood stem cell transplantation(PBSCT) for patients with leukemia and the prophylaxis of complications.Methods:Three patients with leukemia were treated with unrelated-donor PBSCT.The regimens for prophylaxis of acute graft-versus-host disease (GVHD) were:CTX+TBI for case 1,CTX+TBI+ATG for case 2,and CTX+VP16+TBI+ATG for case 3.The numbers of transfused mononuclear cells and CD34 + cells were:5.90×10 8/kg and 6.34×10 6/kg for case 1,6.43×10 8/kg and 2.62×10 6/kg for case 2,6.01×10 8/kg and 2.30×10 6/kg for case 3.The regimen for prophylaxis of acute GVHD was the combination of mycophenolate mofetil(MMF),cyclosporine(CsA) and methotrexate(MTX).Results:All 3 patients were engrafted and hemotopoietic reconstitution was rapid.Over grade Ⅱ acute GVHD were not seen in all 3 patients.Case 1 with chronic myelogenous leukemia relapsed 180 d after transplantation,second remission and disappearance of Ph chromosome were acquired 2 months after discontinuing of cyclosporine.At the same time,the patient developed localized chronic GVHD.Case 2 had localized chronic GVHD 220 d post transplantation.Conclusion: Unrelated donor PBSCT can effectively treat leukemia.The combination of MMF,CsA and MTX can effectively prevent the acute GVHD of unrelated-donor PBSCT.

关 键 词：无血缘关系供体 造血干细胞移植 外周血 白血病 治疗 

分 类 号：R733.705[医药卫生—肿瘤]