异基因造血干细胞移植两种预处理方案的比较  

Comparison of Two Conditioning Regimens in Treatment of Leukemia by Allogeneic Hematopoietic Stem Cell Transplantation

作　　者：张国材[1] 郑冬[1] 管迅行[2] 罗绍凯[1] 李娟[1] 彭爱华[1] 童秀珍[1] 赖凤珍[1] 谭恩勋[1] 洪文德[1] 

机构地区：[1]中山大学附属第一医院血液科,广东广州510080 [2]中山大学肿瘤防治中心放疗科,广东广州510060

出　　处：《癌症》2003年第6期620-623,共4页Chinese Journal of Cancer

摘　　要：背景与目的:预处理方案是造血干细胞移植成功的关键因素之一。本研究的目的是比较异基因造血干细胞移植两种预处理方案治疗白血病的优缺点。方法:21例采用白消安(busulfan,BU)16mg/kg加环磷酰胺(cyclophosphamide,CY)120mg/kg方案(BU/CY组);23例采用全身照射(totalbodyirradiation,TBI)7.5～8.5Gy加CY120mg/kg方案(TBI/CY组)。结果:BU/CY组和TBI/CY组3年无病生存率分别为61.5%与64.7%,复发率分别为23.8%与26.0%,两者差异无显著性(P>0.05)。BU/CY组肝脏毒性发生率高于TBI/CY组,分别为80.9%与54.3%(P<0.05),均无发生肝静脉闭塞病。BU/CY组口腔和胃肠道毒性发生率(33.3%与42.9%)则明显低于TBI/CY组(78.2%与78.2%)(P<0.05);膀胱和肺毒性的发生率两组相似,前者为23.8%与26.0%,后者为14.3%与13.0%(P>0.05),但TBI/CY组发生1例致死性的Ⅳ级肺毒性。两组均未发生心脏、肾和中枢神经系统不良反应。结论:BU/CY组疗效与TBI/CY组相当。BU/CY组预处理方案易于实施,患者耐受好,髓外毒性低。BACKGROUND &OBJECTIVE:The conditioning reg imens are the critical factors in the allog ene ic hematopoietic stem cell transpla ntation.This study was conducted to compare the ef fectiveness and side-effects of two conditioning reg imens in allog enei c hematopoietic stem cell transplantation(allo-HSCT).METHODS :Twenty-one cases received busulfan(BU)16mg /kg plus cyclophosphamide (CY)120mg /kg ,the other 23cases receive d total body irradiation(TBI )7.5-8.5Gy plus CY 120mg /kg reg imen.RESULTS :The3-year disease-free survivals(DFS)were 61.5%in BU /CY g roup and 64.7%in TBI /CY g roup,respectively(P>0.05).The relapse rates were 23.8%and26%,respectively,without sig nificant difference(P>0.05).The incidence of liver damag e in the BU /CY g roup was hi g her (80.9%)than that in the TBI /CY g roup(54.3%)(P<0.05),while no case developed hepatic ven o-occlusive disease.Stomatitis and g astrointe stinal toxicity were sig nificantly lower in the BU /CY g roup(33.3%and 42.9%)compared with TBI /CY g roup(78.2%and78.2%),respectively(P<0.05).Bladder toxicity(23.8%and 26%)and pulmonary toxicity(14.3%and 13%)were similar in the two g roups (P>0.05),while one patient in TBI /CY g roup developed g rade IV pulmonary toxicity,which is lethal.No case was found to have cardiac,renal,or central nervous sys tem g rade I toxicity.CONCLUSION:The two g roups have equal effectiven ess ,BU /CY reg imen is relatively easy to admi nister and well tolerated with low extramedullary toxicity.

关 键 词：异基因造血干细胞移植 预处理 耐受性 毒性反应 白血病 

分 类 号：R733.7[医药卫生—肿瘤] R730.5[医药卫生—临床医学]