异基因外周血干细胞移植治疗急性和慢性白血病52例临床观察

Allogenetic peripheral blood stem cell transplantation for patients with acute/chronic leukemia:clinical observation in 52 cases

目的:评价异基因外周血干细胞移植(Allo-PBSCT)治疗血液肿瘤的疗效。方法:用Allo-PBSCT治疗血液肿瘤患者52例[急性淋巴细胞白血病(ALL)11例,急性髓系白血病(AML)12例,慢性粒细胞白血病(CML)29例]。预处理方案为含TBI(21例)与不含TBI的高剂量化疗方案(31例),采用环孢素加骁悉加甲氨喋呤(MTX)常规预防性控制移植物抗宿主病,非亲缘关系移植加用抗胸腺细胞球蛋白(ATG)。结果:52例患者移植后造血功能均重建,急性移植物抗宿主病(aGVHD)发生率23.1%,慢性移植物抗宿主病(cGVHD)发生率21.2%,其中局限型占15.4%;9例患者于移植后1～16月分别死于移植物抗宿主病、感染和疾病复发或进展,35例患者已PFS3～46个月,ALL-首次完全缓解(CR1)9例,无病存活(DFS)5例,带病生存2例,死亡2例,ALL-不缓解(NR)2例,死亡2例;AML-CR18例,DFS6例,带病生存2例,AML-CR24例,DFS2例,带病生存1例,死亡1例;CML(慢性期)22例,DFS19例,带病生存2例,死亡1例,CML(加速期)4例,DFS2例,带病生存1例,死亡1例,CML(急变期)3例,DFS1例,死亡2例。结论:异基因外周血干细胞移植是目前有可能治愈血液肿瘤的惟一方法。CML慢性期和急性白血病CR1后尽早选择异基因造血干细胞移植。

Objective：To evaluate the therapeutic effect of allogenetic peripheral blood stem cell transplantation （Allo-PBSCT） for acute/chronic leukemia. Methods： Fifty-two patients （ALL in 11 cases, AML in 12 cases, CML in 29 cases） received AIlo-PBSCT following conditioning regimens with TBI in 21 cases or high dose chemotherapy without TBI in 31 cases. Prophylactic preventing graft-versus-host disease （GVHD） was adopted with cyclospo- rine A （CsA）/mycophenolate mofetil （MMF）/methotrexate （MTX） and additional ATG for unrelated-- donor PBSCT. Results：All patients obtained hematopoieteic reconstitution. The incidence rate of Acute GVHD was 23. 1 %, and chronic GVHD was 21.2 % （limited 15.4% ）. Nine patients died of GVHD, infection, disease relapse or development, and thirty-five patients were disease-free survival （DFS） from 3 to 46 months. Of patients, 9 was ALL-CRl（first time CR） ： 5 in DFS, 2 in live with disease（LWD）, 2 in death; 2 was ALL-NR： 2 in death; 8 was AML-CRI： 6 in DFS, 2 in LWD; 4 was AML-CR2 （second time CR）： 2 in DFS, 1 in LWD, 1 in death; 22 was CML（chronic phase） ： 19 in DFS, 2 in LWD, 1 in death; 4 was CML （accelerated phase） ： 2 in DFS, 1 in LWD, 1 in death; 3 was CML （acute transformation phase） ： 1 in DFS, 2 in death. Conclusion：Allo-PBSCT is an only effective approach for the cure of patients with acute/chronic leukemia. It is strongly recommended that CML （chronic phase） and AL-CR1 adopt Allo-PBSCT therapy as soon as possible.