亲缘间HLA半相合外周血造血干细胞移植治疗急性白血病的临床研究

目的探讨HLA半相合外周血造血干细胞移植（PBSCT）治疗急性白血病的疗效及安全性。方法4例急性白血病患者行HLA不全相合PBSCT，其中急性淋巴细胞白血病2例，急性非淋巴细胞白血病-M4b1例、M4EO1例，移植时均处于完全缓解状态。HLA配型1、2个位点不合各1例，3个位点不合2例。预处理方案由全身照射或白消胺、阿糖胞苷、环磷酰胺、司莫司汀组成。移植物抗宿主病（GVHD）的预防采用环胞素A、甲氨蝶呤、霉酚酸酯、抗胸腺细胞球蛋白四联方案。结果患者移植过程顺利，4例患者均获得造血功能重建并达完全供者植人。3例出现Ⅰ度急性GVHD，1例出现Ⅱ度急性GVHD。1例并发巨细胞病毒间质性肺炎，2例并发真菌肺炎。至今2例患者分别无病存活30月和15月，1例目前为移植后4月，1例死亡。结论HLA半相合PBSCT疗效较好、安全可行，为无HLA完全相合供者的白血病患者提供了新的治疗手段。

Clinical Study of HLA Partially Mismatched Peripheral Blood Stem Cell Transplantation from Relative Donors for Treatment of Acute Leukemia

Objective To explore the efficiency and safety of HLA partially mismatched peripheral blood stem cell transplantation （PBSCT） for treatment of acute leukemia. Methods Four patients with acute leukemia in complete remission, including two with acute lymphocytic leukemia and two with acute non-lymphocytic leukemia-M4, were treated by HLA partially mismatched PBSCT. Of the four patients, one was HLA1 locus mismatched, one HLA2 locus mismatehed and the other two with HLA3 locus mismatched. Preconditioning regimen consisted of total body irradiation or administration of busulfan, Ara-c, cyelophosphamide and Me-CCNU. Cytosporin A, methotrexate, myeophemolate mofetil and antithymus globulin were used to prevent graft versus host disease （GVHD）. Results The transplantation was successful in all the four patients who obtained hematopoletic reconstiution and full donor-type engraftment. Grade Ⅰ acute GVHD （aGVHD） occurred in three patients and grade Ⅱ aGVHD occurred in one patients. Two patients suffered from interstitial fungal pneumonia, and another one suffered from interstitial cytomegalovirus pneumonia. At present, three patients were alive and disease-free for 30, 15 and 4 months respectively, and one patient died. Conclusion HLA partially mismatched PBSCT is an effective and safe therapy for acute leukemia. It can provide a new method for the treatment of leukemia patients who have no related matched donors.