异基因外周血干细胞移植治疗恶性血液病的临床研究

Allogeneic peripheral stem cell transplantation(PBSCT) for hematological malignancies

目的 评价异基因外周血干细胞移植（ａｌｌｏＰＢＳＣＴ） 治疗恶性血液病的疗效。方法 用异基因外周血干细胞移植治疗恶性血液病１６ 例，其中急性淋巴细胞白血病５ 例（ＣＲ１ ４ 例，ＣＲ２ １ 例） ， 急性非淋巴细胞白血病２ 例（ＣＲ１） ，慢性粒细胞白血病８ 例（ＣＰ５ 例，ＡＰ３ 例） ，非霍奇金淋巴瘤１ 例（ＰＲ） 。中位年龄３３（１８ ～４９） 岁。预处理方案：ＴＢＩ９ ～１０ Ｇｙ（ 分２ 次照射） ＋ ＣＴＸ １２０ ｍ ｇ／ｋｇ 或ＴＢＩ１０Ｇｙ ＋ＣＴＸ１２０ ｍｇ／ｋｇ ＋ Ｖｐ１６ ５００ ｍｇ 。预防移植物抗宿主病（ ＧＶＨＤ） 方案：ＣｓＡ＋ 短程ＭＴＸ。供者年龄中位数３２（１４ ～５２） 岁， 用ＧＣＳＦ５μｇ ·ｋｇ － １ ·ｄ － １ ×５ ～６ 天进行造血干细胞动员， 分离单个核细胞中位数９ ×１０８／ｋｇ［５ ．７９ ～１３ ．７０） ×１０８／ｋｇ］ ，ＣＤ３４ ＋ 细胞中位数１３ ．９ ×１０６／ｋｇ［５ ．６９ ～４９ ．００） ×１０６／ ｋｇ］ 。结果全部患者移植后均重建造血，仅１ 例（ＡＢＯ 血型不合） 红系延迟重建。粒细胞＞ ０ ．５ ×１０９／ Ｌ 中位数１２（１０ ～１５） 天，血小板＞ ３０ ×１０９／Ｌ 中位数１３（８ ～２４）

Objective To evaluate the efficacy of allo PBSCT in hematological malignancies. Methods Sixteen patients with hematological malignancies were treated by allo PBSCT, started from march 1997. Five of them were ALL (CR1 4,CR2 1), 2 ANLL (CR1), 8 CML(CP 5,AP 3),and one NHL(PR). The median age was 33(18～49) years. Conditioning regimen was TBI 9～10 Gy+CTX 120 mg/kg,or TBI 10Gy+CTX 120 mg/kg+Vp16 500mg. A combination of cyclosporine and methotrexate was administered to prevent acute GVHD. All donors received G CSF 5μg·kg-1·d-1 for 5 to 6 days. One or three leukapheresis procedures were performed by CS 3000 plus blood cell separator to collect a median mononuclear cells of 9×108/kg recipient weight [rnge(5.79～13.7)×108/kg],including a median CD34+cells 13.9×106/kg[rnge(5.69～49.00)×106/kg].Results All patients were engrafted and hematopoietic reconstitution was rapid: neutrophils achieving 0.5×109/L on day 12 (range, 10～15),platelets >30×109/L on day 13 (range, 8～24). More than grade ⅡaGVHD occurred in 3(18.7%), and localized cGVHD in 3 patients. Leukemia relapse occurred in one patients. The median follow up duration was 13 months. Eleven patients were alive in disease free situation. Conclusion Allo PBSCT can rapidly reconstitute hematopoiesis with incidences of aGVHD and cGVHD not more than that in BMT.