异基因外周血干细胞与异基因骨髓移植治疗白血病疗效的比较

Investigation of the Therapeutic Efficacy Between Allogeneic Perpheral Blood Stem Cell Transplantation and Bone Marrow Transplantation

[目的]比较异基因外周血干细胞移植(allo-PBSCT)和异基因骨髓移植(auo-BMT)治疗白血病的临床疗效.[方法]allo-PBSCT治疗15例,BMT治疗17例.预处理方案:环磷酰胺(Cy)60 mg/(kg@d)×2 d+单次全身照射7.5～8.0 Gy;或白消安(Bu)4 mg/(kg@d)×4 d+Cy 60 mg/(kg@d)×2 d.[结果]32例均植活,中性粒细胞恢复至＞0.5×109/L和血小板＞20×109/L的中位时间allo-PBSCT组分别14 d和15 d,allo-BMT组分别为20 d和23 d(P＜0.05).allo-PBSCT组移植相关死亡3例(20%),复发3例(20%),9例无病生存,2年无病生存率为64%±10%:allo-BMT组相关死亡4例(24%),复发3例(18%),10例无病生存,2年无病生存率为59%±10%;两组比较,差异无显著性(P＞0.05).allo-PBSCT组有5例(33%),BMT6例(35%)出现急性移植物抗宿主病.allo-PBSCT组发生慢性移植物抗宿主病6例(40%),明显高于allo-BMT组2例(12%),P＜0.05.[结论]allo-PBSCT疗效与allo-BMT相当,但allo-PBSCT慢性移植物抗宿主病发生率高.

[Objective] To compare the efficacy of allogeneic peripheral blood stem cell transplantation (allo-PBSCT) and allogeneic bone marrow transplantation (allo-BMT) in Leukemia. [Methods] 15 patients received allo-PBSCT and 17 received allo-BMT in our hospital, conditioning regimens were cyclophos-phamide(Cy) 60 mg/(kg.d) × 2 d plus single total body irradiation(STBI) 7. 5 ~ 8. 0 Gy or Busufan (Bu) 4 mg(kg .d)×4 d plus Cy 60 mg/(kg.d) ×2 d. [Results] 32 patients were successfully grafted. The median time for neutrophil > 0. 5 ×109/L and platelet > 20×109/L was 14 and 15 days for the allo-PBSCT group, and 20 and 23 days for the allo-BMT group respectively. Transplant-related death was found in 3 patients (20% ) of the allo-PBSCT group and 4 (24% ) of allo-BMT group. 3 patients (20% ) in allo-PBSCT and 3 (18% ) in allo- BMT relapsed. 9 patients in allo-PBSCT and 10 in allo-BMT were alive in disease-free situation (DFS). The 2 year probabilities of DFS for allo-PBSCT and allo-BMT group were 64% ±10% and 59% ±10% respectively ( P > 0. 05). Acute graft versus host disease (aGVHD) occured in 5 patients (33% ) in allo-PBSCT group and 6 (35% ) in the allo-BMT group. While chronic graft versus host disease (cGVHD) was found in 6 (40% ) and 2 (12% ) respectively (P < 0. 05) . [Conclusion] The clinical outcome of allo-PBSCT is similar to that of allo-BMT except for a higher incidence of cGVHD.