难治性恶性血液病的异基因外周血干细胞移植治疗

PERIPHERAL BLOOD STEM CELL TRANSPLANTATION IN PATIENTS WITH REFRACTORY MALIGNANT BLOOD DISEASES Da Wanming, Wang Cunbang, Liu Yuan, et al

目的观察异基因外周血干细胞移植治疗难治性恶性血液病的疗效。方法应用Ｇ（Ｍ）－ＣＳＦ动员的ＨＬＡ完全相合同胞（５例）和半相合亲属（１例）外周血干细胞移植治疗６例难治性恶性血液病，包括３例慢性粒细胞白血病（２例加速期，１例急变耐药），从未缓解和耐药复发淋巴瘤各１例，１例急性淋巴细胞白血病第３次复发。移植前预处理方案为高剂量联合化疗加全身照射。移植的单个核细胞、ＧＭ－ＣＦＵ和ＣＤ＋３４细胞平均分别为４．９×１０８／ｋｇ、１２．５×１０４／ｋｇ和４．２×１０６／ｋｇ。结果移植后造血功能皆重建。染色体、红细胞血型及亚型检查证实均移植成功。２例发生Ⅱ度急性ＧＶＨＤ，３例发生慢性ＧＶＨＤ，经治疗很快控制。６例的原发病皆达完全缓解，且随访至今４例无病存活，２例ＣＣＲ＋５８ｄ和＋１１８ｄ后分别死于间质性肺炎和心肌病。结论异基因外周血干细胞移植是治疗晚期恶性血液病的较好选择，加强对移植后并发症的防治，可望获得长期生存率。

Objective To evaluate the use of allogeneic peripheral blood stem cell transplantation (PBSCT) in place of bone marrow transplantation for treatment of patients with refractory malignant blood diseases. Methods Allogeneic PBSCT from HLA identical siblings (5 cases) and HLA haploidentical mother (1 case) was used to treat 6 patients with refractory malignant blood diseases. Among them, 3 were chronic myeloid leukemia (2 in acelerated, 1 with resistance in blastic phase), 1 is malignant lymphoma who never achieved complete remission after several intensive chemotherapy and local irradiation, and 1 acute lymphoblastic leukemia in 3rd relapse. Harvest of PBSC started after mobilisation with G(M) CSF for 5 days. Performing 1 3 procedures, we collected at least 2.6×10 8/kg BM nucteated cells, 7.4×10 4/kg GM CFU,and 2.3×10 6/kg CD + 34 cells. The conditioning regimen included high dose combination chemotherapy (VCR,VP 16 ,Ara C, Mitoxantrone and cyclophosphemide),and total body irrdiation (TBI).Results After allogeneic PBSCT,the hematopoiesis recovred in 3 weeks, and acute graft vesus host disease (GVHD) was observed in 2 patients, chronic GVHD in 3 cases.Complete remission are obtained in all 6 patients post transplantation, 2 of them died on +54 and +118 day from myocarditis and interstitial pnoumonia, respectively. 4 cases are still alive in disease free with the median follow up of 14.5 months.Conclusion PBSCT is a potential choice to cure the refractory malignant blood diseases.