G-CSF动员的异基因外周血干细胞和骨髓联合移植治疗白血病

Clinical Study on Transplantation of G-CSF-Mobilized Allo-PBSC and Allo-Bone Marrow for Leukemia Patients

为了探讨粒细胞集落刺激因子(G-CSF)动员的异基因外周血干细胞和骨髓联合移植治疗白血病的疗效, 给予供者G-CSF 8-10μg／(kg·d),皮下连续注射5天,以动员外周血和骨髓干细胞,在第4,5天采集外周血干细 胞,第7天采集骨髓;预处理采用氟达拉宾,白消安和环磷酰胺组成的新方案。结果表明,12例全部成功植入,中性 粒细胞>0.5×109／L的时间为10.2(9-12)天,血小板>20×109／L的时间为12.5(12-14)天。移植后观察100 天,4例(33.3％)发生Ⅱ度急性移植物抗宿主病(aGVHD),10例出现慢性移植物抗宿主病(cGVHD),中位随访时 间5个月,2例死亡,余10健康生存。结论:G-CSF动员的和外周血造血干细胞骨髓联合移植是安全有效的治疗方 法,可以获得长期稳定的植活并不增加aGVHD和cGVHD等并发症。

To study clinical outcome of G-CSF-mobilized allo-peripheral blood stem cell (PBSC) and allo-bone marrow ( BM) transplantation for patients with leukemia, donnors were injected G-CSF 8-10 μg/( kg · d) for 5 days, PBSC were collected on day 4-5 and G-CSF mobilized BM was extracted on day 7. Conditioning regimen consisting of fludarabine,busulfan and cyclophosphamide. The results showed that transplanted cells in all patients were engrafted, the median days of neutrophil exceeding 0.5 × 109/L and platelet exceeding 20 × 109/L were 10.2 days (range 9-12 days) and 12. 5 days (range 12 - 14 days), respectively. Patients were monitored up to 100 days, 4 of 12 patients (33. 3% ) developed n aGVHD, 10 of 12 patients(83. 3% ) developed limited cGVHD. The median follow-up duration was 5 months. Two patients died,the others were alive in disease-free situation. In conclusion, allogeneic transplantation of G-CSF mobilized PBSC plus BM was safe and effective treatment for patients with leukemia , the therapy provides rapid and sustained engraftment without increase in incidence of aGVHD and cGVHD.