异基因外周血造血干细胞移植治疗恶性血液病(英文)

Allogeneic Peripheral Blood Hematopoietic Stem Cell Transplantation in Malignant Hematopoietic Diseases

为观察异基因外周血造血干细胞移植 (allo PBSCT)治疗急慢性白血病的疗效 ,从 1997年 3月至 2 0 0 3年 1月共进行了 2 1例急慢性白血病的Allo PBSCT。 2 1例的供者中 19例为HLA Ⅰ /Ⅱ抗原完全相合的同胞 ,1例慢性粒细胞白血病急粒变患者的供者为HLA半相合母亲 ,1例女性急性淋巴细胞白血病患者的供者为 1个B位点不合的胞妹。 2 1名供者均用rhG CSF动员 ,第 5天起用CS 3 0 0 0plus分离外周血单个核细胞 1-3次 ,预处理方案采用常用的TBI与联合化疗方案。所有病人均采用环胞菌素A和短程MTX进行移植物抗宿主病的预防。结果表明 ,移植后粒细胞恢复至≥ 0 .5× 10 9/L平均为 12天 ,血小板恢复至≥ 2 0× 10 9/L为 15天。 17例患者中发生急性GVHD 8例 (47% ) ,其中 1例为子母间移植 ;慢性GVHD 12例 (70 % ) ;4例存活的女性患者 ,包括 1例 1个B位点不合的ALL患者 ,均无急、慢性GVHD发生。 10 0天移植相关死亡 3例 (14 % ) ,复发 2例 (9.5% ) ,均为移植时未缓解患者。至报告时无病存活 11例 (52 .4% ) ,存活时间平均 40 (15-70 )个月。结论 :Allo PBSCT后造血恢复较快、白血病复发率相对较低 ,急性和重度GVHD的发生并无明显增加 ,但慢性GVHD发生率明显增高 。

To evaluate the use of allogeneic peripheral blood stem cell transplantation (allo-PBSCT) for treatment of acute and chronic leuke mia, from Mar ch 1997 to January 2003, 21 adult patients with malignant hematopoietic diseases underwent allo-PBSCT from HLA-identical siblings (19 patients) and haplo-ide nt ical mother (one) and one B point site mismatched sibling (one). All donors we re mobilized with G-CSF for 4 days and peripheral blood stem cells were collect ed by CS-3000 separator. The conditioning regimen included the high dose combin ation chemotherapy and TBI. Cyclosporine-A (CsA) plus a short course of MTX was used for GVHD prophylaxis in all patients. The results showed that after trans plantation, median time for the recovery of granuocyte ≥0.5×10 9/L and platelets≥20×10 9/L were 1 2 (10-20) and 15 (11-35) days, respectively. Acute GVHD was observed in 8/17 p atients (47%), of which one transplanted from HLA-haploidentical mother. Chro nic GVHD occurred in 12/17 patients (70%). All of four female survivals did not show acute and chronic GVHD. Day 100 transplantation-related mortality was 14% (3/21). Relapse occurred in two patients(9.5%) who underwent allo-PBSCT i n stage of non-remission at one and six months. After follow-up of 40 (15-70) months, 11 patients (52.4%) are still disease-free survival. These results suggested that periphe ral blood stem ce lls produce a faster hematopoietic recovery and a lower relapse of leukemia. The rate of aGVHD is not increased when using the peripheral blood as source of ste m cells; however, cGVHD continues to be a significant problem. Donors tolerated the procurement procedure without complications.