异基因造血干细胞移植治疗白血病临床总结  

Summary on clinical outcome of allogeneic stem cells transplantation in leukemia patients.

作　　者：刘霆[1] 李建军[1] 贾永前[1] 徐才刚[1] 向兵 黄杰[1] 何茜[1] 王晖[1] 管利君[1] 卢忠平[1] 鲁建春[1] 

机构地区：[1]四川大学华西医院,四川成都610041

出　　处：《四川医学》2004年第3期269-271,共3页Sichuan Medical Journal

摘　　要：目的　总结 84例异基因造血干细胞移植 (包括 :同胞异基因造血干细胞移植、无血缘关系异基因造血干细胞移植和脐血干细胞移植 )治疗白血病的疗效和生存状况。方法　预处理方案CML采用标准BuCy方案 (马利兰 4mg/kg·d× 4,环磷酰胺 60mg/kg·d× 2 ) ;ALL采用E TBICy方案 (VP 165 0mg/kg× 1,TBI10 0 0～ 110 0cGy ,分 3次完成 ,CTX60mg/kg·d× 2 ) ;AML采用BuACy方案 (马利兰 4mg/kg·d× 2 ,Ara c3 .0g/m2 ·d× 2 ,CTX60mg/kg·d× 2 )。移植物抗宿主病的预防采用CsA +MTX +IVIg方案。结果　 84例中 47例仍然无病存活 ( 5 4 7% )。移植后 10 0天存活 64人 ( 75 2 % ) ;10 0天内死亡原因分别为 :急性GVHD ,MOF ,CMV间质性肺炎 ,播散性感染 ,早期复发 ,和植入失败 ;移植后 10 0天～ 2年内死亡 16例 ,死亡原因分别为疾病复发、CMV感染和慢性GVHD ,移植后存活超过 2年者中无死亡病例 ,最长生存已 9年。CML61例目前仍无病存活 3 7例 ( 60 6% ) ,AML15例仍无病存活 7例 ( 4 6 6% ) ,ALL8例仍无病存活 3例 ( 3 8% )。结论　异基因造血干细胞移植可使相当部分白血病患者获得长期无病存活 ,其中部分患者获得治愈。本组患者移植后 10 0天内死亡原因主要是急性GVHD ;移植后 10 0天～ 2年内死亡的主要原因是疾?Objective To anlalyze and summarize the clinical outcome of allogeneic stem cells transplantation in  patients with leukemia.Methods The preparation regimens were used based on the patientsy disease classification,such as Regimen Bucy for CML(busulfan 4mg/kg/day for 4 days, cydlophosphamide 60mg/kg/day for 2days,and total body irradiation 1000～1100cGy dividing to 3 daily dosage),and Regimen BuACy for AML (busulfan 4mg/kg/day for 2 days,arabinosyleytosine 3.0g/m 2/day for 2 days,and cyclophosphamide 60mg/kg/day for 2 days).The methotrexate,cyclosporine,and intravenous immunoglubin were used for GVHD prophylaxis.Results 47 of 84 patients are alive without disease(54.7%),and 64 patients were alive at 100-day after transplantation(75.2%).The causes of death within 100 days after transplant ation were ordinal as acute GVHD,multiple organ failure,CMV interstitial pneumonia,disseminated in fections,early relapse,and implant failure.16 patients died in 100 days to 2 years post transplantation from disease relapse,CMV interstitial pneumonia,and chronic GVHD.There is no death case in two years after transplantation,and the longest survival has been more than 9 years.The disease-free survival is 60.6%,46.6%,and 38% in CML,AML,and ALL,respectively.Conclusion Allogeneic stem cells transplantation is effective to enhance the disease-free survival in leukemia patients and can be a curable approach for them.Based on our outcome,the main cause for early death was acute GVHD,and the main causes for late death were disease relapse and CMV infection.We must emphasize that it is important to treat the complications related to transplantation correctly,and furthermore,pay more attention to providing the monitoring and guideance to patients for their early recovery after transplantation.

关 键 词：白血病 治疗 异基因造血干细胞移植 

分 类 号：R733.7[医药卫生—肿瘤]