外周血造血干细胞移植治疗恶性血液病16例临床总结

Clinical Summary of Peripheral Blood Stem Cell Transplantation for Malignant Hematologic Diseases

目的：观察外周血造血干细胞移植（peripheral blood stem cell transplantation，PBSCT）对恶性血液病的临床疗效。方法：对16例恶性血液病患者进行PBSCT，其中9例行异基因PBSCT（allo-PBSCT），7例行自体PBSCT（auto-PBSCT）。allo-PBSCT采用粒细胞集落刺激因子（G-CSF），auto-PBSCT采用化疗联合G-CSF动员外周血造血干细胞。预处理方案采用改良的白消安／环磷酰胺或全身照射／环磷酰胺方案。allo-PBSCT患者接受CD34^＋细胞中位数为6．43×10^6／kg，auto-PBSCT患者接受CD34^＋细胞中位数为5．7×10^6／kg。allo-PBSCT患者移植物抗宿主病（GVHD）的预防采用环孢素A联合短疗程甲氨蝶呤，部分患者加用霉酚酸酯，2例人类白细胞抗原（HLA）不全相合患者加用抗胸腺细胞球蛋白。结果：全部患者均成功植入并快速重建造血，中性粒细胞恢复至≥0．5×10^9／L、血小板恢复至≥20×10^9／L的天数，在auto-PBSCT分别为12～18天和14-22天，在allo-PBSCT中分别为14～21天和16-26天。allo-PBSCT中Ⅰ-Ⅳ度急性GVHD的发生率为33．3％，慢性GVHD的发生率为77．8％。全组总死亡率18．8％。结论：auto-PBSCT和allo-PBSCT均能很快重建造血，是治疗恶性血液病最有效的手段之一。预防和治疗GVHD仍然是PBSCT中的重要问题。

Objective ：To determine the efficacy of peripheral blood stem cell transplantation（PBSCT） on malignant hematologic diseases. Methods ：9 patients were treated by allogeneic PBSCT（auto-PBSCT）and 7 patients were treated by autologous PBSCT（auto-PBSCT）. Peripheral blood stem cells were mobilized with granulocyte colony-stimulating factor（G-CSF） on allo-PBSCT and chemotherapy combined with G-CSF on auto-PBSCT. Amended busulfan/cyclophosphamide or total body irradiation regimen was used in PBSCT groups. Allo-PBSCT group received infusion of CD34^＋ cells at a median of 6. 43 × 10^6/kg,auto-PBSCT group received infusion of CD34^＋ cells at a median of 5.7 × 10^6 cells/kg. Cytosporin A and methotrexate was administered to prevent graft-versus-host disease（GVHD） on alIo-PBSCT group. Mycophemolate mofetil was administered in some patients and antithymus globulin （ATG） was administered in 2 patients with mismatched locus. Results ： All patients were successfully engrafted and hematopoietic reconstruction was rapid. The median time for neutrophils to reach 0. 5 × 10^9/L and platelets to reach 20 × 10^9/L were 14 days （12-18 days） and 10 days （14-22 days） in auto-PBSCT group, 17 days （14-21 days） and 20 days （16-26 days） in allo-PBSCT group. In allo-PBSCT,Grade I-IV acute GVHD（aGVHD） occurred in 33.3% , and chronic GVHD（cGVHD） developed in 77.8% cases. Over-all death rate was 18.8%. Conclusion：PBSCT can provide rapid hematopoietic reconstruction. It is one of the most effective methods to treat malignant hematopathy. It is of great importance to the clinical transplantation and to prevent and cure GVHD.