异基因外周血干细胞移植治疗白血病27例.DOCVIP

临床医学论文-异基因外周血干细胞移植治疗白血病27例 ?????????????? 作者：白庆咸，陈协群 ，王文清，董宝侠，李蕊，石梅，李琳?? 【Abstract】AIM：? To observe the efficacy and main complications of allogeneic peripheral blood stem cell transplantation（alloPBSCT） in 27 patients with leukemia. METHODS:? Twentyseven leukemia patients including 10 acute myeloid leukemia (AML), 8 acute lymphocytic leukemia (ALL) and 9 chronic myelogenous leukemia (CML) received allo-PBSCT from HLAidentical sibling （n = 25）and 1~2 locus mismatched sibling（n = 2）. Conditioning regimen consisted of cyclophosphamide and total body irradiation plus Arac/VP16（n=13） or busulphancyclophosphamide（n = 14）. Graft versus-host disease (GVHD) prophylaxis was the standard methotrexate and cyclosporine combination. ATG and CD25 monoclonal antibody was given in one case of 2-locus mismatched alloPBSCT. RESULTS:? Twenty-seven patients got sustained engraftment. ⅡⅢ degree acute GVHD and chronic GVHD were found in 3/27(11%) and 7/27(26%) patients, respectively. Idiopathic pneumonia syndrome occurred in 1 case. Pure red cell aplasia lasted for 8 months in one patient with major ABO and Rh incompatible PBSCT. With a followup of 2 to 30 months, 20/27(74%) patients were still alive and 7/27 (26%) died of leukemia relapse. CONCLUSION:?Allogeneic peripheral heamatopoietic stem cell transplantation is an effective therapy for leukemia, but there is high rate of relapse in patients with highrisk and refractory status before transplantation. 　　【Keywords】? leukemia;? peripheral blood stem cell transplantation； allogene 　　【摘要】目的： 探讨异基因外周血干细胞移植治疗白血病的疗效及主要并发症的处理.方法： 接受异基因外周血干细胞移植的白血病患者27例，年龄16~50岁，其中急性髓细胞白血病(AML)10例,　急性淋巴细胞白血病(ALL) 8例，慢性髓细胞白血病(CML) 9例.HLA完全相合同胞供者25名， 1~2个HLA主要位点不合同胞供者2名.采用环磷酰胺联合全身放疗(CYTBI)为主的预处理方案或白消安联合环磷酰胺(BuCY2 )方案预处理.采用标准环孢霉素A（CsA）联合短期甲氨蝶呤（MTX）预防移植物抗宿主病（GVHD）.2个HLA主要位点不合的1例移植患者加用兔抗人胸腺球蛋白(ATG)及抗CD25单克隆抗体.结果： 全部患者均获得稳定植入，ⅡⅢ 度急性GVHD 3例(11%)，慢性GVHD 7例.并发特发性间质性肺炎1例.ABO血型主要不合及Rh血型不合的CML患者并发纯红细胞性再生障碍性贫血1例.随访2~30 mo，存活20例(74%)，移植后4~11 mo死于白血病复发7 例(26%). 结论： 异基因外周血