非清髓异基因外周血造血干细胞移植治疗慢性粒细胞白血病

Nonmyeloablative allogeneic peripheral blood stem cell transplantation for the treatment of chronic myeloid leukemia

目的 :探索非清髓异基因外周血干细胞移植 (NST)治疗不能耐受清髓性异基因造血干细胞移植的慢性粒细胞白血病 (CML)患者的疗效。方法 :将 5例CML患者中的 4例以全身放疗加氟达拉宾 ,1例以马利兰、氟达拉宾加抗人胸腺细胞免疫球蛋白为预处理方案 ,联合环孢霉素A、霉酚酸酯和 (或 )短程氨甲蝶呤预防移植物抗宿主病。结果 :5例均造血重建 ,3例完全供者型植入 ,2例混合型植入 ,其中 1例植入率持续低于 5 0 % ,经 2次清髓性异基因造血干细胞移植后达到完全供者型植入。 2例发生Ⅰ度急性移植物抗宿主病 ,1例发生Ⅳ度急性移植物抗宿主病 ,无慢性移植物抗宿主病发生。中位随访时间 5 (337)个月 ,无病生存 3例 ,死亡 2例。结论 :对不能耐受清髓性异基因造血干细胞移植的CML患者 。

Objective:To explore the feasibility of nonmyeloablative allogeneic peripheral blood stem cell transplantation for chronic myeloid leukemia patients who were not suitable for conventional myeloablative allogeneic stem cell transplantation.Method:Four of five cases were conditioned by fludarabine and total body irradiation,while one case with fludarabine, busulfan and anti-T-lymphocyte globulin. All cases received cyclosporine A, mycophenolate mofetil and/or low-dose methotrexate as the prophylaxis against GVHD.Result:Rapid engraftment was observed in all.Three of five cases resulted in complete chimerism,and the other two cases resulted in mixed chimerism.One case whose engraftment rate was less than 50% resulted in complete chimerism after secondary myeloablative allogeneic stem cell transplantation. The incidence of acute GVHD was 3/5 ( 2 cases grade Ⅰ, 1 case grade Ⅳ). No chronic GVHD was observed in all cases. After a follow-up of median 5 (range 3-37) months, 3 of 5 patients remained disease free survival.Conclusion:Nonmyeloablative allogeneic peripheral blood stem cell transplantation is a safe and effective option for the patients with CML who were not suitable for myeloablative allogeneic stem cells transplantation.