同种胎肝移植治疗急性白血病及随访

Follow-up study of acute leukeamia treated with allogenic fetal liver transplantation(FLT)

近十年来国外骨髓移植(BMT)治疗白血病迅速发展,并取得较满意的效果。但骨髓移植受HLA配型相合的限制,选择供体困难,不易广泛应用。近年来在动物实验的基础上,国内外少数单位已开展胎肝造血干细胞移植治疗白血病的尝试,并取得了初步的疗效。我院自1983年5月～1988年2月用胎肝移植治疗白血病9例,现报告如下。

Nine patients with acute leukaemia underwent FLT during 1st complete remission in 7 ases and 2nd or 3rd remission in 2 cases, 4 cases suttered from ALL, 2 from APL, each of the ther 3 from AMMoL, AML, and AEL. Their age ranged from 6—25 years. The preconditioning egimen ncluded CTX 80—120mg/kg+Danuomycin 20—60mg (or Ara-c 300mg) followed by 5—7 Gy TBI with a ose of 0.0423—0.13 Gy' Min. Among 6 cases treated with single dose TBI (STBI) and fresh FIT, chieved bone marrow reconstruction, 4 of whom showing engraftment evidence. Three cases have een surviving for 53, 45, and 30 months respectively after FLT without further systemic hemotherapy while 2 patients died of severe complicalion. Three patients who received ractional TBI and cryo-FLT all achieved BM reconstruction. The remission duration in 1 of them as more than 20 months.The results suggest that the incidence of BM reconstruction, ngraftment emission duration and survival time treated with 5—7 Gy in our series are better than those eported by Izzi, who adopted TBI 10 Gy in their regimen. It also shows that better results ould be achieved if the transplantation is given during the 1st CR than in the 2nd remission. he curative effect of cryo-FLT is comparable to that of fresh FLT. The cryo-FLT has the dvantage in selecting the sex and age of the fetus and in controlling the quantity and quality f fetal liver cell preparation, which plays a key role in achieving a HLA-matched FLT therapy.