异基因外周血造血干细胞移植治疗慢性髓细胞白血病的临床研究

为了评价异基因外周血造血干细胞移植 (allo PBSCT)治疗慢性髓细胞白血病 (CML)的疗效 ,作者对 12例CML进行了allo PBSCT的临床研究 ,12例均为第 1次慢性期 ,中位年龄 32 .5岁 ;全部供受者HLA配型完全相合 ,供者动员用G CSF 5 μg/ (kg·d)× 5天 ,分离外周血单个核细胞 (2 .49.5 7)× 10 8/kg(中位数 5 .0× 10 8/kg) ,CD 34 + 细胞数为 (0 .72 6 6 .30 )× 10 6/kg(中位数 5 .82× 10 6/kg)。预处理方案 :9例采用全身照射 (TBI) +环磷酰胺 (CTX) +依托泊甙 (VP16 ) ,3例采用TBI +CTX ;移植物抗宿主病 (GVHD)预防采用环孢素A(CsA) +短程甲氨喋呤 (MTX)方案。全部患者均顺利造血重建 ,中性粒细胞 >0 .5× 10 9/L中位数 14.5天 (142 3天 ) ,血小板 >2 0× 10 9/L中位数 16天 ;发生Ⅱ度以上急性GVHD 3例 (2 5 % ) ;慢性GVHD共 5例 ,其中局限性 3例 ,广泛性 2例 ;死亡 3例 ,2例死于感染 ,1例死于间质性肺炎 ,中位随访 6个月 ,存活 9例。Allo PBSCT急性GVHD发生率并不比异基因骨髓移植高 ,但慢性GVHD的发生应引起重视

ALLOGENEIC PERIPHERAL BLOOD STEM CELL TRANSPLANTATION(PBSCT) FOR CHRONIC MYELOGENOUS LEUKEMIA

To observe the efficacy of allo-PBSCT in chronic myelogenous leukemia(CML), twelve patients with chronic phase CML were treated with allo-PBSCT. The median age was 32.5 years. Donors received G-CSF 5μg／(kg*d) for 5 days. A median mononuclear cell of 5.0×108/kg recipient weight [range （2.4～9.57）×108/kg], including a median CD34+ cell of 5.82×106/kg [range （0.72～66.30）×106/kg] , was collected. Conditioning regimens for nine patients and three patients were TBI+CTX+VP16 and TBI + CTX respectively. The extra radiation of spleen was given to three patients with splenomegaly. All patients were engrafted and hematopoietic reconstitution was rapid, with neutrophils recovering to over 0.5×109/L on day 14.5（range 14～23）and platelets >20×109/L on day 16 (range 9～35）.Over grade Ⅱ acute GVHD occurred in three patients(25%) and chronic GVHD occurred in five patients, including three patients with localized chronic GVHD and two with extensive chronic GVHD . The incidence of acute GVHD in allo-PBSCT is similar to allo-BMT, while care should be taken for the occurrence of chronic GVHD.