自体造血干细胞移植治疗恶性血液病

Autologous Hematopoietic Stem Cell Transplantation in Treatment of Malignant Hematopathy

目的 评价自体造血干细胞移植 (AHSCT)治疗恶性血液病的疗效。 方法 用 AHSCT治疗白血病及恶性淋巴瘤患者共 5 8例 ,年龄 31.9± 10 .5 (14～ 5 8)岁。其中急性非淋巴细胞白血病 (ANL L ) 30例 (CR1 2 4例 ,CR2 5例 ,CR31例 ) ,急性淋巴细胞白血病 (AL L ) 18例 (CR1 13例 ,CR2 3例 ,CR32例 ) ,慢性粒细胞白血病 (CML ) 3例 (均获血液学缓解 ) ,恶性淋巴瘤 7例 (CR4例 ,PR3例 )。预处理化疗方案选用以下药物中任意两种或三种联合 :阿糖胞苷 3～ 4g/ m2 ,环磷酰胺 4～ 6 g/ m2 ,鬼臼乙叉苷 (VP- 16 ) 0 .5～ 1.0 g/ m2 。除 5例联合全身骨髓照射 (剂量为7～ 8Gy) ,其余均单用化疗。 结果 所有患者移植后均重建造血 ,移植相关死亡 1例 (1.72 % )。ANL L、AL L CR1期移植者 3年无病生存率分别为 5 2 .4%± 4.2 %和 46 .1%± 3.5 % ,复发率分别为 37.7%± 4.5 %和 40 .5 %±6 .7%。 10例 CML 和恶性淋巴瘤患者中 ,除 1例 期恶性淋巴瘤患者复发 ,余均获持续完全缓解。 结论 为降低白血病和恶性淋巴瘤的复发率 ,提高患者的无病生存期 ,无造血干细胞供者的 CR1 期白血病及恶性淋巴瘤患者应积极行 AHSCT。

Objective\ To evaluate the therapeutic effect of autologous hematopoietic stem cell transplantation(AHSCT) on malignant hematopathy.\ Methods\ From December of 1989 to November of 1999, 58 patients with median age of 31 9±10 5 (14~58) years received AHSCT, 30 of them were \{acute\} non\|lymphoblastic leukemia(ANLL)(CR\-1 24, CR\-2 5, CR\-3 1), 18 were acute lymphoblastic leukemia(ALL)(CR\-1 13, CR\-2 3, CR\-3 2), 3 were chronic myelogenous leukemia(CML,all acquired hematologically complete remission ) and 7 were malignant lymphoma(4 of CR, 3 of PR).\ 2 or 3 of following agents: Ara\|C 3~4 g/m\+2, CTX 4~6 g/m\+2 and VP\|16 0 5~1 0 g/m\+2, were combined as conditioning regimen in all patients.\ Among them 5 patients accepted additional total body bone marrow irradiation.\ Results\ All the patients have reconstituted bone marrow hematopoiesis after transplantation.\ The transplantation\|related mortality rate was 1 72%(one case).\ The 3\|year disease\|free survival rates of ANLL and ALL at CR\-1 stage were 52 4%±4 2% and 46 1%±3 5% respectively, and the relapse rate were 37 7%±4 5% and 40 5%±4 6% respectively.\ Among 10 patients with CML and malignant lymphoma, 9 achieved continuous complete remission(CCR) except that one case of Ⅳ stage lymphoma relapsed.\ \{Conclusion\}\ Without compatible donors, patients with leukemia and malignant lymphoma at CR\-1 stage could receive AHSCT to reduce relapse and increase disease\|free survival.