异基因外周血造血干细胞和骨髓混合移植治疗白血病12例

Allogeneic bone marrow transplantation combined with peripheral blood stem cell transplantation for 12 malignant hematologic diseases

目的探讨异基因外周血造血干细胞和骨髓混合移植治疗白血病的疗效。方法 12例白血病患者,人白细胞抗原（HLA）配型全相合11例,2个位点不相合1例,采用粒细胞集落刺激因子（G-CSF）动员的外周血造血干细胞和骨髓联合移植,环孢素A联合甲氨蝶呤加/不加吗替麦考酚酯方案预防移植物抗宿主病（GVHD）。结果 12例患者均获得异体植活,中性粒细胞（ANC）〉0.5×109L-1,血小板（BPC）〉20×109L-1的中位时间分别为移植后的11 d（10-15 d）和14.5 d（11-43 d）。有3例发生了Ⅰ度急性GVHD,1例发生了Ⅱ度急性GVHD。在可评估的7例患者中有1例出现了局限的慢性GVHD。有3例患者因白血病复发而死亡,另1例因植活后感染死亡,其余8例中位随访时间13个月（2-29个月）,均无病生存。结论外周血造血干细胞和骨髓混合移植对HLA配型全相合和部分相合患者是安全有效的移植方法。

Objective To study curative effect and clinical outcome in 12 recipients undergoing allogeneic peripheral blood stem cell transplantation（PBSCT）combined with bone marrow transplantation（BMT）.Methods 12 patients underwent granulocyte-colony stimulating factor（G-CSF） mobilized allogeneic peripheral blood stem cell transplantation plus bone marrow transplantation.11 cases were matched for HLA antigens,1 case was two loci mismatched.All patients received cyclosporine A and methotrexate combined with or not mycophenolate mofetil to prevent graft versus host disease（GVHD）.Results All patients got endurable engraftment.The median number of days of absolute neutrophil counts（ANC） exceeding 0.5×109L-1 and platelet count exceeding 20×109L-1 was 11d（range 10～15d） and 14.5 d（range 11~43 d）,respectively.4 of 12 patients developed acute graft versus host disease（aGVHD）,3 being in the grade Ⅰ and 1 being in grade Ⅱ.One of the evaluable 7 patients developed limited chronic graft versus host disease（cGVHD）.3 patients died of relapsed leukemia.1 patient died of severe infectious complications.The other 8 patients were still alive and event-free with a median follow-up duration of 13 months（range 2~29 months）.Conclusion PBSCT combined with BMT is safe and effective for patients with matched or mismatched of HLA antigens to cure leukemia.