交替半身照射综合方案治疗急性白血病残留病的临床观察

Alternative Half-Body Irradiation Combined Scheme for Patients with Residual Disease of Acute Leukemia

目的:观察交替半身照射综合方案对急性白血病残留病的治疗效果。方法:对9例急性白血病患者经标准化疗缓解后,进行强化疗预处理(环磷酰胺120mg/kg)+交替半身照射(上半身照射7～7.5Gy,下半身照射8～9Gy)+过激免疫治疗(结核菌素纯蛋白衍生物,rhIL2激活的自体骨髓细胞)的综合方案治疗;观察指标:动态观察治疗前后的血象、骨髓象、骨髓GMCFU改变;采用筑巢式PCR检测残留病的方法和12-ο-十四烷酰佛波醋酸酯-13(12οtetradecanoylphorbol13acetateTPA)诱导分化试验观察治疗效果。结果:9例患者血象、骨髓象、骨髓GMCFU于治疗完成后2-3周均能自行恢复至正常水平,无严重毒副作用。筑巢式PCR检测表明,本组残留病4例转为阴性,2例弱阳性,3例阳性。9例患者经该方案治疗后均未作巩固化疗,现最长已持续缓解27个月,最短为4个月,中位缓解期1.5个月。结论:交替半身照射综合方案,对残留白血病有良好的治疗效果。该方案毒副作用轻,费用低,可能有推广应用前景。

Objective:This study was designed to investiga te the effect of alternative half-body irradiation combined scheme on treatment for the patients with residual disease of acute leukemia.Methods :Five patients with acute leukemia were treated with combination of con dition treatment[cytoxan(CTX)120mg /kg],alternative half-body irradiatio n(upper body irradiation with 7-7.5gray and lower body irradiation with 8-9gray),and immunotherapy(BCG-PPD,rhIL-2activing auto-bone marrow cells)after remission with standard chemo therapy.Dynamic changes of blood an d bone marrow figures,granulocyte-macrophage c olony-forming unit(GM-CFU)of bone marrow before and after treatment were observed.Reverse transcriptase polymerase c hain reaction(RT-PCR)and 12-ο-tetradecanoyl-phorbol-13-aceta te(TPA)induced differentiation assay were used to e valuate the effect.Results:In all 9cases,blood and bone marrow f igures,GM-CFU numbers of bone marrow were automati cally recovered to normal level at 2-3weeks after treatment without severe side effect.The detection of residual di sease with RT-PCR at 6months after tr eatment showed that 4negative cases,2weak positive cases,and 3positive cases had recurred at 27and 4month,respec tively.The median remission time wa s 1.5months.Conclusion:The alternative half-body irradiation combined scheme is markedly effe ctive to leukemia.Its side effect was very slight.The cost was more lower and it is easy to implement.