非血缘脐血移植治疗高危急性白血病的临床研究

Clinical study on treatment of high-risk acute leukemia with unrelated cord blood transplantation

目的：探讨非血缘脐血移植（UCBT）治疗儿童和成人高危急性白血病的效果。方法对高危急性白血病10例患者进行脐血移植，儿童3例，成人7例，中位年龄29岁（11～41岁）。6例接受单份脐血移植，4例接受双份脐血移植。采用清髓性不含抗胸腺细胞球蛋白（ATG）预处理方案。在白消安（Bu）加环磷酰胺（Cy）基础上加用阿糖胞苷（Ara-C）、氟达拉滨（Flu）或全身照射（TBI）。移植物抗宿主病（GVHD）预防采用环孢素及吗替麦考酚酯。结果8例（80％）患者获得成功植入，白细胞植入中位时间为19 d （14～25 d），血小板植入中位时间为40 d （33～60 d）。3例患者发生急性 GVHD，无1例发生慢性 GVHD。中位随访时间为24个月（1～29个月），7例患者无病存活。2年总体存活率及无病存活率均为66.7％。结论UCBT 治疗高危急性白血病是可行的，对于无 HLA 相合同胞供者的高危患者，UCBT 可作为首选，其 GVHD 发生率低、复发率低，有可能使急性白血病患者长期生存。

Objective To investigate the effect of unrelated cord blood transplantation （UCBT）on the treatment of high-risk childhood and adult acute leukemia.Methods Ten patients with high-risk acute leukemia underwent UCBT.Among the 1 0 patients,3 were children and 7 were adults with the median age of 29 years old （1 1 -41 years old）.Six patients underwent one-unit cord blood transplantation and four patients underwent two-unit cord blood transplantation.The myeloablative conditioning regimen without antithymocyte globulin （ATG）was adopted.Cytarabine （Ara-C）,fludarabine （Flu）or total body irradiation （TBI）was added on the basis of busulfan （Bu）and cyclophosphamide （Cy）.Ciclosporin and mycophenolate mofetil were used to prevent graft-versus-host disease （GVHD）.Results The transplantation was successful in 8 （80%） patients.The median implant-time of leukocytes was 1 9 d（1 4-25 d）and that of platelets was 40 d（33-60 d）.Three patients developed acute GVHD and no patient developed chronic GVHD.The median follow-up time was 24 months （1 -29 months）.Seven patients remained in disease-free survival.Both the 2-year overall survival and disease-free survival rates were 66.7%.Conclusions UCBT is feasible in the treatment of high-risk acute leukemia.UCBT is the preferred option for the high-risk patients without HLA-identical sibling donors,which is characterized by low incidence of GVHD and low recurrence rate.It may make patients with acute leukemia remain long-term survival.