非清髓性异基因造血干细胞移植治疗恶性血液病  

Non-myeloablative Allogeneic Stem Cell Transplantation in Patients with Hematologic Malignancies

作　　者：苏丽萍[1] 乔振华[1] 许莲蓉[1] 马梁明[1] 姜波[1] 朱秋娟[1] 叶芳[1] 鹿育晋[1] 崔月娥[1] 朱镭[1] 张丽[1] 马香兰[1] 李蓉萍[1] 

机构地区：[1]山西医科大学第二医院血液科,太原030001

出　　处：《中国实验血液学杂志》2004年第1期63-66,共4页Journal of Experimental Hematology

基　　金：国家 8 63课题 ;编号 2 0 0 2AA2 160 81

摘　　要：为了研究非清髓性异基因造血干细胞移植 (non myeloablativeallogeneicstemcelltransplantation ,allo NST)治疗恶性血液病的疗效及相关技术 ,对 2 6例恶性血液病患者 (急性白血病 10例 ,慢性髓性白血病 14例 ,多发性骨髓瘤 2例 )中 14例采用FAC预处理 (Fludara +ATG +CY) ,12例采用MAC预处理 (马法兰 /马利兰 +ATG +CY) ,用G CSF 6 0 0 μg/d或G CSF 30 0 μg/d +GM CSF 30 0 μg/d进行外周血干细胞动员 ,第 5天开始采用CobeSpectra血细胞分离机连续采集 2 - 3次 ;环孢菌素A联合短程甲氨蝶呤预防GVHD ;移植后第 4周开始供体淋巴细胞输注 ,首剂 1×10 7/kg ,之后依据临床反应及嵌合体形成情况 ,每 4周 1次 ,剂量逐级递增 ;以微卫星短串联重复序列 (STR)分析、Bcr/Abl融合基因、Ph染色体、HLA位点分析、性染色体及ABO血型等为植活检测指标。结果表明 ,植入率 84 .6 2 % ,其中 18例已转为完全供体型 ;aGVHD发生率 11.5 4 % ,cGVHD发生率 2 3 0 7% ;感染、出血等毒副反应发生率低、反应轻。结论 :非清髓性异基因造血干细胞移植治疗恶性血液病疗效确切 ,毒副作用小 ,但相关技术 ,如适应证的选择、预处理方案、移植过程中的免疫治疗等需要进一步深入研究。In order to investigate the clinical efficacy of non-myeloablative allogeneic stem cell transplantation (allo-NST) and related technology in patients with hematologic malignancies, twenty-six cases of hematological malignancies (10 AL, 14 CML, 2 MM patients) received NST following conditioning regimens with fludara+cyclophosphamide+ATG (14 cases) and busulfan or melphalan+cyclophosphamide+ATG (12 cases), G-CSF (600 μg/d) or G-CSF (300 μg/d) +GM-CSF (300 μg/d) were used for mobilizing peripheral blood stem cell. A combination of cyclosporine A (CsA) and methotrexate (MTX) was administered for GVHD prophylaxis. Patients will be eligible for donor lymphocyte infusion (DLI) or donor stem cell infusion (DSI) given in graded increments according to the chimeric formation and clinical reaction. Generally the dose of the first infusion was 1×10 7/kg at 4th week post-transplantation. The engraftment analysis included the detection of microsatellite short tandem repeats (STRs), Bcr/Abl fusion gene, Philadephia chromosome, HLA-locus analysis, sex chromosome and ABO blood type or blood subtype. The results showed that 22 patients (84.62%) were engrafted, among which 18 patients were full donor chimerism (FDC) up to now. Acute GVHD occurred in 3/26 cases (11 54%). Chronic GVHD was diagnosed in 6 of 26(23.07%) evaluable patients. The incidence of infection and hemorrhage was low and slight. It is concluded that allo-NST is a safe and effective therapeutic method for hematologic malignancies, but the related technology such as selection of indication, conditioning regimen and transplantation immunotherapy should be studied further.

关 键 词：造血干细胞移植 异基因干细胞移植 非清髓性干细胞移植 恶性血液病 

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