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人类白细胞抗原不相合造血干细胞移植治疗白血病的临床研究
引用本文:黄晓军,陈育红,韩伟,陈瑶,洪虹,陆道培.人类白细胞抗原不相合造血干细胞移植治疗白血病的临床研究[J].北京大学学报(医学版),2003,35(2):115-118.
作者姓名:黄晓军  陈育红  韩伟  陈瑶  洪虹  陆道培
作者单位:北京大学人民医院血液病研究所,北京,100044
摘    要:目的 :探讨应用人类白细胞抗原 (humanleukocyteantigen ,HLA)不相合供体造血干细胞移植治疗白血病。方法 :总结我所于 2 0 0 0年 7月至 2 0 0 1年 12月进行的 7例HLA不相合造血干细胞移植 ,其中包括 3例慢性髓性白血病、3例急性非淋巴细胞性白血病、1例急性淋巴细胞白血病。干细胞来源 :6例为外周血干细胞 ,1例为骨髓干细胞。预处理方案为改良马利兰 (busulfan ,BU) /环磷酰胺 (cyclophosphamide,CY)或BU/CY +抗胸腺细胞球蛋白 (antithymocyteglobulin ,ATG)。预防急性移植物抗宿主病 (graftversushostdisease,GVHD)采用环孢霉素A及短疗程氨甲喋呤 ,5例患者加用霉酚酸酯 (骁悉 )。结果 :1例为骨髓造血干细胞 ,采集骨髓单个核细胞数 3 .4 1× 10 8kg-1,6例为粒细胞集落刺激因子 (granlocytecolony stimulatingfactor,G CSF)动员后外周血干细胞 ,平均接受8.4 6× 10 8kg-1(4.3 0× 10 8~ 15 .3 5× 10 8kg-1)供者外周血单个核细胞 ,平均 + 13天 (+ 11~ + 16天 )中性粒细胞(absoluteneutrophilcount,ANC)大于 0 .5× 10 9L-1。平均 + 16天 (+ 11~ + 2 3天 )血小板大于 2 0 .0× 10 9L-1。发生急性Ⅰ~Ⅱ度GVHD 3例 (42 .9% ) ,无 1例严重的急性GVHD ,发生慢性广泛性GVHD 2例 (2 8.6% )。中位随访时间 1

关 键 词:HLA不相合  造血干细胞/移植  白血病/治疗  移植物抗宿主病
文章编号:1671-167X(2003)02-0115-04

Human leukocyte antigen mismatched hemopietic stem cell transplants for the treatment of leukemia
HUANG Xiaojun,CHEN Yuhong,HAN Wei,CHEN Yao,HONG Hong,LU Daopei.Human leukocyte antigen mismatched hemopietic stem cell transplants for the treatment of leukemia[J].Journal of Peking University:Health Sciences,2003,35(2):115-118.
Authors:HUANG Xiaojun  CHEN Yuhong  HAN Wei  CHEN Yao  HONG Hong  LU Daopei
Institution:Institute of Hematology, Peking University People's Hospital, Beijing 100044, China.
Abstract:OBJECTIVE: To explore the feasibility of HLA mismatched hemopietic stem cell transplants for the treatment of leukemia. METHODS: Between July 2000 and December 2001, seven patients received hemopietic stem cell transplants(HSCT) with HLA mismatched family donors, including 3 chronic myelocytic leukemia (CML), 3 acute nonlymphocytic leukemia (ANLL), and 1 acute lymphocytic leukemia (ALL). Stem cell sources were bone marrow(n = 1) or G-CSF mobilized peripheral blood (n = 6). All the patients were conditioned with busulfan (BU) 12 mg.kg-1 and cyclophosphamide (CY) 3.6 g.m-2, of whom 4 were conditioned with additioned antithymocyte globulin(ATG). Graft versus host disease (GVHD) prophylaxis regimen consisted of cyclosporin-A (CSA), methotrexate (MTX) and mycophenolate mofetil(MMF). RESULTS: One patients received 3.41 x 10(8) kg-1 mononuclear cells(MNC) from bone marrow; six patients received a mean number of 8.46 x 10(8) kg-1 (4.3 x 10(8)-15.4 x 10(8) kg-1) MNC from peripheral blood. The mean time of ANC > 0.5 x 10(9) L-1 was day 13 (11-16), and BPC > 20.0 x 10(9) L-1 was day 16 (11-23). All the patients got engraftment successfully and attained CR. Acute I-II GVHD occurred in 3(42.9%) patients, no acute III-IV GVHD occurred and extensive chronic GVHD did in 2(28.6%) patients. All the patients were alive and well after 6-24 months' follow-up. CONCLUSION: (1) BU/CY plus ATG appears to be an effective conditioning regimen for HLA mismatched allogenic stem cell transplants. (2) G-CSF mobilized peripheral blood stem cells may be the source of stem cells even for HLA mismatched hemopietic stem cell transplants.
Keywords:HLA mismatch  Hematopoietic stem cell transplants  Leukemia/ther  Graft versus host disease
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