摘要
目的 探讨 4 0例异基因外周血干细胞移植 (allo PBSCT)的植活情况 ,移植物抗宿主病 (GVHD)的发生率和严重性 ,以及临床结果。方法 1997年 6月至 1999年 5月我院施行了 4 0例 (中位数年龄 35岁 )allo PBSCT。以G -CSF 5μg kg ,每 12小时1次 ,连续 5天皮下注射动员外周血干细胞 ;输入CD34+ 细胞中位数为 7 7(2 0 - 16 8)× 10 6 kg ;BU CY2为预处理方案 ;34例采用环孢素A+ 甲氨蝶呤 ,6例用环孢素A+ 甲基泼尼松龙预防GVHD。结果 中性粒细胞和血小板植活中位数时间分别为 13天 (9- 2 8)和 12 (7- 6 0 ) ;输入CD34+ 细胞≥ 4× 10 6 kg或移植后给予G CSF者中性粒细胞和血小板植活显著加速 ;4 0例中 17例 (42 5% )发生aGVHD ,其中Ⅱ Ⅵ度aGVHD10例 (2 5% ) ;中位数随访 380天 (180 - 90 0 ) ,在可评价的 30例中 2 1例 (70 % )发生cGVHD ;移植相关死亡率为17 5% ,复发率为 10 % ,3年无白血病生存概率为 72 5%。结论 研究结果表明allo PBSCT能快速重建造血 ,aGVHD发生率并不增高 。
Objective To observe engraftment kinetics, the incidence and severity of graft-versus-host disease (GVHD), and clinical outcome on 40 recipients undergoing allogeneic peripheral blood stem cell transplantation (allo-PBSCT).Methods From June 1997 to May 1999, forty leukemia patients with a median age of 35 years underwent allo-PBSCT. PBSC were mobilized with G-CSF at a dose of 5 μg/kg s.c. every 12 hours for 5 days. A median of 7.7 (2.0 - 16.8) × 106 CD34+ cells/kg was infused into the recipients. Busulfancyclophosphamide (BU-CY) was used as the conditioning regimen. All patients received cyclosporine A and either methotrexate ( n = 34) or methylprednisolone ( n = 6) for GVHD prophylaxis.Results Engraftment of neutrophils and platelets was achieved at a median of 13 days (9- 28 days) and 12 days (7- 60 days) respectively. Patients receiving ≥4×106 CD34+ cells/kg or given G-CSF post transplant had significantly accelerated neutrophil and platelet engraftment. Acute GVHD occurred in 17 of 40 patients (42.5％), with grade Ⅱ-Ⅳ acute GVHD in 10 patients (25％). Chronic GVHD developed in 21 (9 extensive, 12 limited) out of 30 evaluable patients (21/30, 70％) with a median follow up of 380 days (180-900 days). Transplant related mortality was 17.5％ end the relapse rate was 10％. The probability of leukemia free survival at 3 years was 72.5％.Conclusion Allo-PBSCT can provide rapid hematopoietic reconstitution without an increased incidence of acute GVHD, but may be associated with a high risk of chronic GVHD.
