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 blood stem cell transplantation in the treatment of hematological malignacies

目的 :探讨异基因外周血干细胞移植 (allo PBSCT)治疗恶性血液病的临床疗效。方法 :以粒细胞集落剌激因子 (G CSF) 5μg·kg- 1 ·d- 1 动员外周血造血干细胞 ;预处理方案为TBI加VEAMC方案 ;输入CD34 + 细胞中位数为 5 .4(3 .2 0～ 9.33)× 1 0 8个 /kg ;用环孢素A加甲氨喋呤或甲基泼尼松龙防治移植物抗宿主病 (GVHD)。结果 :移植后ANC及PLT中位重建时间分别为 1 5d、1 9d ;1 5例中有 6例发生aGVHD(40 .0 % ) ,有 7例发生cGVHD(46 .6 % ) ;1 5例中有 6例 (40 .0 % )死亡 ,其中死于间质性肺炎 3例 ,因复发死亡 2例 ,死于GVHD引起的肝功能衰竭 1例 ;9例 (60 .0 % )患者无病生存。结论 :allo PBSCT有造血重建快、感染等移植相关死亡发生率低等优点 。

Objective:To observe clinical outcome in 15 patients with hematological malignancies undergoing allo PBSCT.Method: 15 hematological malignant patients underwent allo PBSCT PBSC were mobilized with G CSF at a dose of 5 μg/kg /d S.C.for 5 days.TBI+VEAMC(VCR,VP 16,Ara C,MIT,CY) were used as conditioning regimen.A median of 5.4 (range 3.20 to 9.33 )×10 6 CD 34 + cells /kg was infused into the recipients.All patients received cyclosporine A and either methotrexate or methylprednisolone for GVHD prophylaxis or therapy.Result: Engraftment of neutrophils and platelets was achieved at a median of day +15 and day +19 respectively. Acute GVHD occurred in 6 of the 15(40%),chronic GVHD developed in 7 of all( 46.6 %)with a median follow up of 24 months(range 1 to 52).6 patients (40%) died including three of interstitial pneumonia,two of relapse and one of chronic GVHD in liver,and 9 patients(60%) were still in disease free survival.Conclusion: Allo PBSCT can provide rapid hematopoietic reconstitution and low transplantation related mortality or toxicity without an increased incidence of acute GVHD or relapse rate.