HLA半相合外周血造血干细胞移植治疗急性白血病的临床观察

Clinical Study on Haploid HLA-Matched Peripheral Blood Stem Cell Transplantation in the Treatment of Acute Leukemia

目的:探讨HLA半相合外周血造血干细胞移植(peripheral blood stem cell transplantation,PBSCT)治疗急性白血病的效果及安全性。方法:4例急性白血病行HLA半相合PBSCT,其中急性淋巴细胞白血病2例,急性非淋巴细胞白血病2例,移植时均处于完全缓解状态。HLA配型1、2个位点不合各1例,3个位点不合2例。预处理方案由全身照射或白消安、阿糖胞苷、环磷酰胺、甲基洛莫司汀组成。移植物抗宿主病(graft versus host disease,GVHD)的预防采用环胞素、甲氨蝶呤、麦考酚吗乙酯、抗胸腺细胞球蛋白四联方案。结果:4例均获得造血功能重建。2例出现Ⅰ度急性GVHD,2例出现Ⅱ度急性GVHD。1例并发巨细胞病毒间质性肺炎,2例并发真菌肺炎。至今3例无病存活29、15和2个月,1例死亡。结论:HLA半相合PBSCT疗效较好、安全可行,为无HLA完全相合供者的白血病患者提供了新的治疗手段,但要特别注意移植后病毒和真菌感染的防治。

Objective：To explore the efficiency and safety of haploid HLA-matched peripheral blood stem cell transplantation（PBSCT） in the treatment of acute leukemia. Methods：4 patients with acute leukemia were treated by PBSCT,including 2 acute lymphocytic leukemia,2 acute non-lymphocytic leukemia,all of whom were in complete remission. 2 patients had HLA 1 and 2 locus mismatched. The other 2 patients both had HLA 3 locus mismatched. Conditioning regimen consisted of total body irradiation or Busulfan, Ara-c, Cyclophosphamide and me- CCNU. Cytosporin,Methotrexate,Mycophemolate Mofetil and Antithymus Globulin were used to prevent graft versus host disease（GVHD）. Results： All of the 4 patients had hematopoietic reconstitution and full donor type engraftment. Grade I acute GVHD occurred in 2 patients and grade II occurred in 2 patients. 2 of the 4 patients had inter-current epiphyte pneumonia. One had inter-current cytomegalovirus intersti- tial pneumonia. Up to now,3 patients are still alive and disease-free for 29,15 and 2 months respectively. 1 patient died. Conclusion： HLA partially mismatched with PBSCT is an effective and safe therapy. It can provide a new method for the treatment of leukemia patients who have no related matched donors,but special attention must be paid to prevent and treat the infection of epiphyte and virus after transplantation.