异基因骨髓移植治疗白血病

自1981年至1985年,作者为8例白血病患者进行了异基因骨髓移植。其中7例达持久性植活,且无白血病复发。骨髓移植后存活最长时间已超过56个月,他们是中国异基因骨髓移植成功的首批病例。另外一例死于严重的GVHD。     

应用RT-nest-PCR法检测慢性髓细胞白血病非亲缘异基因骨髓移植后微小残留病变

目的：应用筑巢式RT—PCR（RT—nest-PCR）法检测慢性髓细胞性白血病（CML）患者非亲缘异基因骨髓移植（URD）后微小残留病变（MRD），并探讨它与复发的相关性。方法：分别采用RT-nest—PCR法和常规细胞遗传学方法检测bcr／abl融合基因和Ph染色体。结果：20例CML行URD患者术前Ph染色体和bcr／abl融合基因检测均为阳性，移植术后30dPh染色体皆转为阴性，bcr／abl融合基因完全转阴时间为1～3个月，中位时间2个月；在随防的18例CML患者中，有16例患者bcr／abl融合基因完全转阴后没再转为阳性。在1例复发的CML患者中可见到血型、Ph染色体和bcr／abl融合基因动态变化，另1例CML患者在移植成功后的21个月和36个月检测到bcr／abl融合基因，经随访未见临床和血液学复发征象。结论：检测bcr／abl融合基因是目前观察CML患者非亲缘异基因骨髓移植后微小残留病变最敏感的方法之一，非亲缘异基因骨髓移植能最大限度地消除CML患者体内残留病变，患者能长期无病生存。     

同基因骨髓移植治疗急性白血病无病生存七年

异基因骨髓移植（All。－BMT）是可治愈急性白血病的有效方法。而同基因骨髓移植，因其特殊原因，疗效远次于Allo－BMT。本文报道1例急性早幼粒细胞白血病（APL）经同基因骨髓移植后，随访至今，已无病生存（DFS）7年余。．五病例介绍患者男，19岁。1988年在外院确诊APL，诱导缓解期间曾有2次脑膜白血病发生，经过IIOAP方案及脑白治疗达完全缓解，后在我院又行DA方案强化1疗程，于1989年5月10日入无菌层流室。当时体检均正常，无潜在感染灶，血液及骨髓均示完全缓解，计划预处理前，患者再次头痛，脑脊液细胞数30个／mm’，颅压升…     

急性白血病完全缓解后巩固维持化疗的长期随访

骨髓移植尤其是异基因移植较之普通化疗的优越性，国内外均有文献报告［１，２］，但异基因骨髓移植需有供髓者，加上年龄、经济等诸多因素的限制，相当部分达完全缓解（ＣＲ）的急性白血病患者实际上无法进行移植。ＣＲ后化疗可能为此部分患者获长期生存的惟一手段。我们...     

大剂量环磷酰胺治疗难治性类风湿关节炎初探

目的：研究大剂量化疗（high-dose chemotherapy,HDC)治疗难治性类风湿关节炎（RA）的可行性，有效性及安全性。方法：对4例常规治疗效果不佳的难治性RA患者进行大剂量环磷酰胺（CTX）治疗，用量为80-100mg/kg，总量4－5g分2－3d给药，观察此4例患者治疗前后的临床转归和实验室改变，并进行相关文献复习。结果：4例难治性RA患者经HDC后，2例随访12个月，2例随访6个月，RA活动指数均明显下降，达ACR50标准病情缓解，且4例患者均对大剂量CTX耐受性良好，无严重不良反应发生，结论：HDC对此4例难治性RA的治疗安全，可行，且临床症状完全缓解，但如何选择合适的病例尚待进一步探讨，HDC能否使病情长期缓解尚有待于更样本的临床病例观察及便长时间的临床随访。     

用BUCY2方案预处理的异基因骨髓移植治疗急性白血病

利用ＢＵＣＹ２方案作预处理对２例急性因病患者实施同种异基因骨髓移植，输入的供体骨髓分别于术后第１８天和１７天植活；ＢＵＣＹ２预处理的毒性较小，化疗反应较易耐受；２例患者均于术后第１８天出现急性移植物抗宿主病（ＧＶＨＤ，Ⅱ级），现已持久植活达２年和１年半，术后５个月复查时，患者的造血系统仍为供体来源。     

异基因骨髓移植后巨细胞病毒肺炎的临床研究

巨细胞病毒感染在异基因骨髓移植后十分常见 ,严重的感染特别是巨细胞病毒间质性肺炎病情重 ,病死率可高达80 % ,直接影响骨髓移植受者的存活率。我院 1998年 11月～2 0 0 2年 11月收治异基因骨髓移植者间质性肺炎 14例 ,其中治愈 5例 ,好转 2例 ,死亡 4例 ,自动出院 3例。对象与方法　 14例异基因骨髓移植伴巨细胞病毒肺炎患者 ,男 7例 ,女 7例 ,年龄 18～ 5 0岁 ,中位年龄 34岁 ,12例行非血缘异基因、2例血缘异基因骨髓移植 ,基础疾病为慢性髓细胞性白血病 8例 ,急性淋巴细胞白血病 1例 ,急性非淋巴细胞白血病 4例 ,多发性骨髓瘤 1例。同…     

自体造血干细胞移植术后并发血栓性微血管病1例

正造血干细胞移植相关的血栓性微血管病(transplatation-associated thrombotic microangiopathy,TA-TMA)是骨髓移植相关的重要并发症,文献报道主要发生在异基因骨髓移植。关于自体造血干细胞移植术后发生TA-TMA文献罕见报道,现就泰安市中心医院(我院)发生自体造血干细胞移植术后并发TA-TMA 1例报道如下。1病例资料患者,女性,30岁,因"发热3d"于2015年1月22日     

急性白血病异基因骨髓移植与维持化疗的存活期与缓解期的比较

本文分析与比较了1981至1987年同期在我所进行化疗取得完全缓解的急性白血病患者,继续进行强化和维持化疗与接受异基因骨髓移植(allo-BMT)病例的缓解期与生存期。接受异基因骨髓移植的8例患者中,仅1例在骨髓移植(BMT)后18个月死于播散型结核,其余7例皆存活,且无白血病复发。而接受强化与维持化疗的23例患者中,其中位完全缓解期仅7个月,中位生存期仅15个月。按Gehan比分检验,结果示二组生存率与缓解期皆有高度显著性差异(P<0.01),说明allo-BMT较单纯化疗优越。     

非清髓异基因外周血造血干细胞移植治疗慢性粒细胞白血病

目的：探索非清髓异基因外周血干细胞移植(NST)治疗不能耐受清髓性异基因造血干细胞移植的慢性粒细胞白血病(CML)患者的疗效。方法：将5例CML患者中的4例以全身放疗加氟达拉宾，1例以马利兰、氟达拉宾加抗人胸腺细胞免疫球蛋白为预处理方案，联合环孢霉素A、霉酚酸酯和(或)短程氨甲蝶呤预防移植物抗宿主病。结果：5例均造血重建，3例完全供者型植入，2例混合型植入，其中1例植入率持续低于50％，经2次清髓性异基因造血干细胞移植后达到完全供者型植入。2例发生Ⅰ度急性移植物抗宿主病，1例发生Ⅳ度急性移植物抗宿主病，无慢性移植物抗宿主病发生。中位随访时间5(3～37)个月，无病生存3例，死亡2例。结论：对不能耐受清髓性异基因造血干细胞移植的CML患者，NST是可行而有效的。     

Marrow transplantation for non-Hodgkin's lymphoma: a multi-centre study from the European Co-operative Bone Marrow Transplant Group

Twenty-five patients with intermediate- or high-grade non-Hodgkin's lymphoma (NHL) were treated by allogeneic bone marrow transplantation. For the nine patients transplanted in first complete remission the disease-free survival was 100%; of the nine patients transplanted in subsequent remissions four (44%) achieved long-term disease-free survival but two died of relapsed lymphoma. For the seven patients transplanted at a time when they had active disease, the initial complete remission rate was high but four died of progressive lymphoma and no patient achieved long-term disease-free survival. The incidence of complications associated with allogeneic bone marrow transplantation was similar to that observed in other series of patients transplanted for haematological malignancy and was related to the status of the disease at the time of transplant. Thus allogeneic bone marrow transplantation is a radical but effective treatment for patients with NHL who have 'minimal residual disease'. Efforts to define further the subset of patients who can most successfully be treated by transplantation may improve the overall results.     

Eosinophilic colitis in a patient with acute myeloid Leukemia after allogeneic bone marrow transplantation

Eosinophilic colitis is a rare inflammatory disease characterized by eosinophilic infiltration of the colon and peripheral blood eosinophilia. We report on a case of eosinophilic colitis in a 29-year-old woman with acute myeloid leukemia following allogeneic bone marrow transplantation from her HLA-identical sister. To our knowledge, eosinophilic colitis has rarely been reported in association with allogeneic bone marrow transplantation.     

Allogeneic bone marrow transplantation for refractory mantle cell lymphoma

 We report about a 28-year-old woman with relapsed mantle cell lymphoma (MCL, centrocytic lymphoma according to the Kiel classification) refractory to salvage chemotherapy. The patient underwent allogeneic bone marrow transplantation from a HLA-identical brother after myeloablative chemotherapy consisting of busulfan, etoposide, and cyclophosphamide. The patient experienced hepatic toxicity (grade I), mucositis (grade II) according the Bearman scale, and graft versus host disease of the skin (grade II) and showed stable engraftment with complete chimerism on day 15 after bone marrow transplantation. Eight years after transplantation, the patient is still disease free and in good condition without any late side effects. This report suggests a curative potential of allogeneic stem cell transplantation in MCL. Received: 23 December 1999 / Accepted: 28 March 2000     

Reactivation of chronic Chagas' disease following allogeneic bone marrow transplantation and successful pre-emptive therapy with benznidazole

This report shows the early detection of reactivation of chronic Chagas’ disease (CCd) in a 27-year-old man with chronic myelogenous leukemia undergoing allogeneic bone marrow transplantation (ABMT). Pre-emptive therapy with benznidazole during a period of 7 weeks led to a rapid recovery of the patient, who remains free of parasitemia 2 years after the bone marrow transplantation.     

Increasing utilization of allogeneic bone marrow transplantation. Results of the 1988-1990 survey.

OBJECTIVE: To determine the pattern and frequency of allogeneic bone marrow transplantation from related and unrelated donors from 1988 to 1990. DESIGN AND SETTING: Survey of 342 institutions in 47 countries. MEASUREMENTS: Numbers of patients receiving bone marrow transplantation for specific disease categories at institutions with active allogeneic bone marrow transplant programs. MAIN RESULTS: Patients (14,745) received allogeneic bone marrow transplantation between 1988 and 1990; of these, 1153 (8%) were from unrelated donors. Reasons for transplantation were acute leukemia (47%), chronic myelogenous leukemia (27%), lymphoma and other malignancies (10%), severe aplastic anemia (9%), and other nonmalignant diseases (7%). The number of allogeneic bone marrow transplants per million persons differed among countries, averaging 7.7 per million in North America and 5.7 per million in western Europe. CONCLUSIONS: The use of allogeneic bone marrow transplantation continued to increase at a rate of more than 600 additional patients and 25 new transplant teams annually. This rise is due in part to increasing use of unrelated volunteers as donors. Resources allocated for transplants vary widely among countries.     

Tretinoin for the treatment of cutaneous graft-versus-host disease

Chronic graft-versus-host disease (GVHD) of the skin is a common complication of allogeneic bone marrow transplantation. It can be resistant to common methods of systemic immunosuppression. We report successful treatment of a patient with progressive cutaneous GVHD that was resistant to cyclosporine and steroids after allogeneic marrow transplantation for acute myelogenous leukemia using topical tretinoin (Retin-A).     

Orthotopic liver transplantation for graft-versus-host disease following bone marrow transplantation

Chronic graft-vs.-host disease occurs in 30%-50% of long-term survivors of allogeneic bone marrow grafts, and may eventuate in cirrhosis. In this study, a young woman, originally diagnosed as having acute myelogenous leukemia, underwent successful bone marrow transplantation but later developed graft-vs.-host disease-induced cirrhosis and recurrent variceal hemorrhage. She underwent successful orthotopic liver transplant. Her postoperative course was uncomplicated, with no evidence of rejection or recurrence of graft-vs.-host disease. As bone marrow transplantation is more widely used and survival improves, the number of patients with graft-vs.-host disease or venoocclusive disease resulting in cirrhosis is likely to increase. Hepatic transplantation should be considered for bone marrow transplant patients who develop end-stage liver disease.     

Bone marrow transplantation for patients with Philadelphia chromosome- positive acute lymphoblastic leukemia

We report the treatment outcome of allogeneic bone marrow transplantation in ten patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Six patients are alive and well for 6 to 30 months (median 19 months) after transplantation. Four patients died with transplant related complications. In view of the poor prognosis associated with this disease, marrow ablation followed by allogeneic or syngeneic marrow grafting may be the preferred treatment modality if a suitable marrow donor is available.     

Immune-mediated encephalomyelitis following varicella-zoster virus infection after allogeneic stem cell transplantation

A 40-year-old Japanese man with acute myeloid leukemia received allogeneic bone marrow transplantation. On day 101, varicella-zoster virus (VZV) infection occurred, but was improved by administration of acyclovir and immunoglobulin. On day 119, he complained of numbness and double vision, and he was admitted due to exacerbation of the symptoms. The findings of cerebrospinal fluid and magnetic resonance image examination were consistent with the diagnosis of immune-mediated encephalomyelitis (IMEM). Intravenous immunoglobulin therapy was effective and his neurological findings dramatically improved without recurrence. IMEM is a rare non-infectious inflammatory demyelinating disease that can occur after transplantation. We herein describe a case report with a review of the associated literature.     

ATP downregulation in mononuclear cells from children with graft-versus-host disease following extracorporeal photochemotherapy

Graft-versus-host disease (GvHD) is a frequent and major complication of allogeneic bone marrow transplantation(BMT). Acute GvHD occurs in 40% to 50% of allogeneic BMT recipients; chronic GvHD can be observed in 30% to 60% of long-term survivors.