自体外周血干细胞移植和自体骨髓移植的临床疗效比较

目的 :比较自体外周血干细胞移植 (APBSCT)与自体骨髓移植 (ABMT)的临床疗效。方法 :用ABMT治疗 2 1例 ,用 APBSc T治疗 2 0例。预处理方案包括全身照射 (TBI) 6 .6～ 8.8Gy加环磷酰胺 (CTX) 10 0～ 12 0 m g/ kg或 TBI 2 .0 Gy加全淋巴照射 (TL I) 4 .0 Gy加 CTX 10 0～ 12 0 m g/ kg加 Vp- 16 6 0 0～ 10 0 0 m g/ m2加环己亚硝脲 (CCNU ) 2 0 0 m g方案或卡氮芥 (BCNU ) 2 0 0 mg/ m2 加 CTX 12 0 mg/ kg加 VP- 16 80 0 m g/ m2 方案或 MAC方案 (马法兰 140 m g/ m2 加 Ara- C 2～ 4g/ m2 加 CTX 12 0 m g/ kg)。结果 :ABMT组造血重建 2 0例 ,移植相关死亡 2例 (9.5 % ) ,复发 4例 (2 0 % ) ,2年无病生存率 (DFS) 6 8.5 0 %± 10 .87% ;而 APBSCT组均获造血重建 ,无移植相关死亡 ,复发 5例 (2 5 % ) ,2年 DFS为 6 2 .34 %± 14.2 6 %。两组差异无显著性意义。结论 :APBSCT与ABMT的疗效相当。     

DC-CIK细胞治疗自体外周血造血干细胞移植后急性髓性白血病的临床研究

目的 采用体外培养的树突状细胞（DC）致敏、细胞因子诱导激活的杀伤细胞（CIK）治疗自体外周血造血干细胞移植后的急性髓性白血病患者,探讨该方法降低自体造血干细胞移植后复发的作用及其临床应用的安全性.方法 将体外培养、扩增的DC-CIK细胞分两次回输给患者.随后给予白细胞介素-2皮下注射,100万U/天,连续10天.观察用药期间的不良反应,治疗结束后定期复查患者血液学及遗传学缓解情况.结果 ①安全性：4例患者9例次治疗均能顺利进行.DC-CIK细胞回输过程中有3例次出现寒战、发热,经对症处理能迅速缓解.治疗过程中未见其它不适反应,心电图、肝肾功能无明显变化;②疗效观察：1例患者在治疗前存在染色体异常（46,xy,inv（16））,一个疗程后染色体检查正常.4例患者治疗结束后均处于持续血液学及遗传学缓解状态.随访至今,4例患者已分别无病生存2年半、2年、2年、1年.结论 DC-CIK细胞治疗急性髓性白血病的安全性较好,不良反应轻微,短期具有一定疗效.是否能有效降低自体外周血造血干细胞移植后急性髓性白血病的复发尚待更多病例的积累,值得开展临床随机对照研究.     

非清髓性自体外周血造血干细胞移植治疗系统性红斑狼疮远期疗效分析

目的探讨非清髓性自体外周血造血干细胞移植(NAST)治疗系统性红斑狼疮(SLE)的远期疗效。方法总结中山大学附属第五医院2002年11月至2005年10月4例成功接受NAST的SLE患者移植后的随访情况。非清髓性预处理移植前1～2 d静脉滴注阿糖胞苷200 mg/(kg.d)及环磷酰胺40 mg/(kg.d)。评价患者移植前后的相关症状体征、远期并发症及免疫功能的变化。结果白细胞总数恢复正常的中位时间12 d,血小板>100×109/L的中位时间为10 d,血红蛋白>120 g/L的中位时间为22 d。随访中,NAST后4例患者临床症状和体症均消失,淋巴细胞亚群检测显示:CD4+及CD4+/CD8+均恢复正常。1例男性患者移植4年后妻子正常受孕并产下一健康女婴。3例女性均恢复正常工作与生活。结论 NAST造血重建快,远期疗效确切。SLE患者NAST治疗后生活质量较好。     

自体外周血造血干细胞移植治疗恶性淋巴瘤16例临床分析

目的：评价自体外周血造血干细胞移植（ＡＰＢＳＣＴ）治疗耐药,复发及晚期恶性淋巴瘤患者的疗效及影响因素,方法采用ＡＰＢＳＣＴ治疗恶性淋巴瘤患者１６例,其中霍奇金病患者２例,非霍奇金淋巴瘤患者１４例,移植时第１次完全缓解６例,第２次完全缓解２例,部分缓解８例;采集外周血造血干细胞均经动员剂动员,其中采用硫酸葡聚糖（ＤＳ）动员２例,惠尔血（Ｇ－ＣＳＦ）动员９例,惠尔血加生白能（Ｇ－ＣＳＦ加ＧＭ－ＣＳＦ）     

自体外周血干细胞混合HLA半相合异体骨髓移植治疗多发性骨髓瘤

目前认为 ,造血干细胞移植是彻底治愈多发性骨髓瘤的唯一方法。在无ＨＬＡ相合的异体造血干细胞供者情况下 ,自体造血干细胞移植成为实现这一目标的较佳治疗方案。我们尝试应用自体外周血干细胞混合ＨＬＡ半相合异体骨髓移植治疗多发性骨髓瘤 ,以期能提高疗效。1　资料与方法1 .1 　 病例介绍患者 ,男 ,35岁。以鼻塞、鼻咽部疼痛半年 ,加重伴两肋及颈腰部疼痛 3个月入院。入院后鼻咽部病理活检示 :呼吸道粘膜浆细胞瘤。查ＩｇＤ3.43ｇ/Ｌ ,Ｋａｐ >2 64ｇ/Ｌ。骨髓象示 :浆细胞 >30 % ,血象正常。骨扫描示 :头颅、颈胸腰椎及肋骨锁骨多处骨…     

自体外周血造血干细胞移植治疗系统性红斑狼疮的初步观察

目的探讨自体外周血造血干细胞移植(APBSCT)治疗系统性红斑狼疮(SLE)的可行性及临床效果。方法对8例女性难治性SLE病人进行APBSCT。采集的干细胞的单个核细胞计数平均为1.6×108/kg[(0.07～2.6)×108/kg]。预处理方案为环磷酰胺(50mg·kg-1·d-1,-5～-2d)静脉滴注及兔抗人淋巴细胞免疫球蛋白(10mg·kg-1·d-1,-3～-1d)静脉滴注。从移植前后皮肤红斑的变化,尿的改变,SLE相关的免疫指标的变化,移植后造血重建情况,移植的并发症等方面进行评价。结果8例病人均获得成功植入,外周血白细胞总数>1.0×109/L的平均时间为9.5d,中性粒细胞计数>0.5×109/L的平均时间为10d,白细胞总数恢复正常的平均时间为14d,血小板计数>50×109/L的平均时间为30d,血红蛋白含量平均在移植后第28天升至100g/L。移植后SLE临床症状均消失,尿蛋白转阴,自身抗体大部分转阴。移植相关并发症中,均出现血清病样预处理反应,2例出现严重的低血压;4例有出血性膀胱炎;2例出现败血症;4例发生霉菌感染;2例发生间质性肺炎。随访时间2个月～2.5年。结论APBSCT治疗SLE有较好的近期疗效,但观察病例及时间有限,远期疗效还需更长时间的观察。对药物治疗难以奏效的SLE病例,该法不失为一种更佳的选择。     

自体外周血造血干细胞采集的护理

自体外周血造血干细胞移植（autologous peripheral blood stem cell transplantation，APBSCT）因采集简便，对造血、免疫功能恢复快，又不受供者的影响，现已经成为恶性血液病、实体瘤，某些自身免疫性疾病等的根治性治疗方法之一。APBSCT成功的基础是获得足够数量的APBSC，而保证造血干细胞采集过程顺利进行是确保造血干细胞产量及质量的关键。本文总结了7例19例次APBSC采集术的护理，现报告如下。     

自体外周血造血干细胞移植治疗恶性淋巴瘤

目的 :报告 7例恶性淋巴瘤在自体外周血造血干细胞移植 (APBSCT)支持下接受超大剂量放、化疗的治疗经验 ,评价所用外周血造血干细胞 (PBSC)动员方案的动员效果 ,预处理方案的疗效和耐受性 ,以及移植后造血重建情况。方法 :7例淋巴瘤患者中 ,1例霍奇金病 ,6例非霍奇金淋巴瘤。动员方案为MOEP/CMOP化疗联合rhG -CSF ,预处理采用经典的超大剂量环磷酰胺 (CTX)化疗联合全身放疗 (TBI)。结果 :APBSCT动员后获得到单个核细胞 4.2 (2 .7～ 6 .1)× 10 8/kg,回输单个核细胞 3.7(2 .5～ 5 .3)× 10 8/kg ,中性粒细胞计数恢复到 >0 .5× 10 9/L的时间和血小板 >5 0× 10 9/L的时间分别平均为第 11.6天和第 14.6天。毒副作用主要为消化道反应。结论 :APBSCT治疗恶性淋巴瘤效果肯定 ,采用MOEP/CMOP联合rhG -CSF动员以及经典CTX加TBI方案预处理 ,安全可靠 ,治疗效果良好。     

自体外周血造血干细胞移植治疗系统性红斑狼疮的临床观察

目的 探讨自体外周血造血干细胞移植(APBSCT)治疗难治性系统性红斑狼疮(SLE)的临床疗效和安全性.方法 10例难治性SLE患者接受APBSCT治疗,应用环磷酰胺(CTX)2～4 g/m2和粒细胞集落刺激因子5～10 μg·kg-1·d-1行外周血造血干细胞动员;预处理包括CTX(50 mg·kg-1·-1,-6～-3 d)和抗胸腺细胞球蛋白(ATG,15～20 mg·kg-1·d-1,-2 d、-1 d、1 d、2 d).患者输注的CD34+细胞＞2×106/kg.评估治疗前后临床表现、SLE疾病活动指数(SLEDAI)和免疫指标的变化.结果 APBSCT后10例SLE患者的临床症状缓解,SLEDAI评分降低,均获得造血重建,中性粒细胞＞0.5×109/L的中位数时间为9.5 d,血小板＞20×109/L中位数时间是11 d;尿蛋白减少或消失,抗核抗体滴度减低或转阴,补体水平升高;移植相关的并发症有:2例败血症,2例巨细胞病毒感染,1例出现肾毒性,3例急性左心衰竭,3例心律失常,无移植相关死亡.结论 APBSCT能够改善SLE患者的疾病活动和免疫学指标,是一种有效的治疗难治性SLE的方法,但远期疗效需进一步观察.     

自体造血干细胞移植治疗急性髓系白血病的疗效及安全性单中心回顾性研究

目的 探讨自体造血干细胞移植治疗急性髓系白血病(AML)的临床疗效及安全性。方法 回顾性分析2017年3月至2022年10月于济宁医学院附属医院血液内科行自体造血干细胞移植治疗的18例AML患者的临床资料。根据法、英、美分型系统(FAB)分型,M₂型3例,M₄型9例,M₅型6例。根据美国国立综合癌症网络(NCCN)指南,低危6例,中危8例,高危4例。其中11例患者为移植前第1次完全缓解(CR₁),7例患者为移植前第2次完全缓解(CR₂)。所有患者的造血干细胞来自于外周血,其中18例采用化疗药物+粒细胞集落刺激因子(G-CSF)动员;2例因第1次采集CD34⁺数量不足,第2次采用普乐沙福动员。18例患者输注CD34⁺计数中位数为4.05×10⁶/kg(1.87×10⁶～27.40×10⁶/kg),单个核细胞计数中位数为14.48×10⁸/kg(4.0...     

Allogeneic hematopoietic cell transplantation in acute myeloid leukemia

Allogeneic hematopoietic cell transplantation (HCT) is a curative treatment modality for select patients with acute myeloid leukemia (AML), functioning as a restorative agent following intensified chemo- and/or radiotherapy and also engendering the disease-directed immunologic threat of graft-versus-leukemia effect. Advancements in conditioning regimen intensity, donor availability, and supportive care have broadened the eligibility for allogeneic HCT, reduced rates of transplant related mortality, and improved outcomes over time. There are still obstacles to transplant in AML, offering opportunities for ongoing discovery, including poor recipient fitness, insufficient donor availability for certain populations, and limited access to care. Relapse remains the most common cause of treatment failure and a high priority area of investigative efforts. Post-transplant maintenance and novel applications of cellular therapeutics are expected to usher in a new era of promise for successful HCT in AML and will aim to overcome the remaining barriers impeding favorable outcomes for these patients.     

Splenic rupture in a patient with acute myeloid leukemia undergoing peripheral blood stem cell transplantation

 Splenic rupture is a rare but well-recognized complication of hematological malignancies. Here, we present the case of a 22-year-old woman with the diagnosis of acute myeloid leukemia who was undergoing peripheral blood stem cell transplantation. On day +10 she developed a hypovolemic shock due to rupture of her spleen and went to emergency laparotomy. This is the first report of splenic rupture during peripheral blood stem cell transplantation. Received: May 7, 1998 / Accepted: October 21, 1998     

BU／CY预处理方案的异基因外周血干细胞移植治疗急性白血病

目的 :观察 BU / CY预处理方案的异基因外周血干细胞移植 (Allo- PBSCT)治疗急性白血病的疗效。方法 :用 BU / CY预处理方案行 Allo- PBSCT治疗急性白血病 5例 ,其中急性淋巴细胞白血病 (AL L ) 4例 (CR13例 ,CR2 1例 ) ,急性非淋巴细胞白血病 (ANL L) 1例 (CR1 )。预处理方案 BU/ CY:BU4m g/ (kg· d)× 4,CTX6 0m g/ (kg· d)× 2。其中 2例 AL L 分别加米托蒽醌 40～ 5 0 m g。用 G- CSF10 μg/ (kg· d)× 5 d进行造血干细胞动员 ,分离单个核细胞 (MNC)中位数 6 .48× 10 8/ kg〔(3.5～ 7.0 )× 10 8/ kg〕。 CD34+细胞中位数 6 .6× 10 6 / kg〔(4.0～9.6 6 )× 10 6 / kg〕。结果 :全部患者移植后均重建造血 ,粒细胞 >0 .5× 10 9/ L,中位数 13d;血小板 >30× 10 9/ L,中位数为 13d;血小板 >5 0× 10 9/ L,中位数为 15 d。发生迟发性出血性膀胱炎 1例 ,白血病复发死亡 1例 ,CMV肺炎死亡 1例。其余 3例分别无病生存 11、9、7个月。结论 :Allo- PBSCT具有造血重建快 ,采集干细胞方便 ,供者易接受等优点     

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。     

Liver transplantation after stem cell transplantation with the same living donor in a monozygotic twin with acute myeloid leukemia

Two monozygotic twins from a Swedish, nonconsanguine family—with concordant acute myeloid leukemia and similar morphological and cytogenetic changes, but with additional changes in one twin, suggestive of clonal evolution—are described. Twin I relapsed 4 months after completion of treatment, while twin II was still on treatment and was transplanted with stem cells from the human leukocyte antigen-identical father. An early relapse after transplantation was treated with donor lymphocyte infusions, but twin I relapsed again and died 8 months after stem cell transplantation (SCT). On relapse of twin I, treatment of twin II was reconsidered and consolidation was intensified with SCT in CR1 with peripheral blood stem cells from the father. Due to irreversible liver failure caused by severe venoocclusive disease, a living, related liver transplantation from the father was performed on day +84 post-SCT. Minimal immunosuppression was required, and graft rejection did not occur. The patient was in complete remission 29 months after SCT and 25 months after liver transplantation.     

Hematopoietic stem cell transplantation for acute myeloid leukemia: A review

Increasing numbers of patients are receiving allogeneic hematopoietic cell transplantation (HCT) for acute myeloid leukemia (AML). Scientific and clinical advances in supportive care, donor selection, and conditioning regimens have resulted in lower transplant-related mortality, extension of care to a wider population of patients, and improvements in survival. Recent era has witnessed an explosive information about the molecular pathophysiology of AML. By early identification of patients at a high risk of relapse, it is expected that a majority of eligible patients will receive HCT in first complete remission. Novel conditioning regimens have been explored to improve transplant outcomes in AML. Currently, a stem cell source can be found for virtually all patients who have an indication to receive HCT. This area of investigation will likely continue to be of intense interest in terms of optimizing transplant outcomes.     

Effectiveness of allogeneic hematopoietic cell transplantation for older patients with acute myeloid leukemia

Outcomes with conventional chemotherapy for older patients with acute myeloid leukemia (AML) remain disappointing, with few cures. For younger patients with AML, allogeneic hematopoietic cell transplantation (HCT) offers the best chance for cure, but this strategy is seldomly used for older patients. With recently improved methodologies, transplantation has become increasingly safe, suggesting that its use in older patients be reconsidered. This report will address four issues: the current frequency of transplantation for AML according to patient age; the impact of patient age on transplant outcomes; the comparative outcomes of transplantation versus chemotherapy for older patients with AML; and possible methods to improve the outcome of allogeneic HCT in older patients with AML.     

Fludarabine, cytarabine, and G-CSF (FLAG) for the treatment of acute myeloid leukemia relapsing after autologous stem cell transplantation

 Twenty-six patients affected by acute myeloid leukemia (AML) who relapsed after autologous stem cell transplantation (ASCT) were treated with the FLAG regimen (fludarabine, cytarabine, and G-CSF). Their median age was 39 years (range 14–59). The median interval from achievement of CR to ASCT was 4 months (2–8). The conditioning regimen was BAVC (BCNU, amsacrine, VP-16, cytarabine) in eight patients, BuCy (busulfan, cyclophosphamide) in 13, and TBI-Cy (total body irradiation, cyclophosphamide) in five. Relapse occurred after a median of 7 months (2–18). ASCT had been performed in CR1 for 23 patients and in CR2 for three. Nineteen patients had been given bone marrow, seven peripheral blood stem cells collected following consolidation plus G-CSF. Overall, CR was obtained by 13 patients (50%), all remitters requiring a single course. The median time for hematological recovery of neutrophils >500/μl and platelets >20,000/μl was 24 and 30 days, respectively. The median duration of G-CSF administration was 25 days, while the median hospitalization was 31 days. There were four deaths in induction (15%), while nine patients (35%) were resistant. After achieving CR, two patients received allogeneic BMT, five a second ASCT, and four were consolidated with HD-ARA-C. Only two patients were judged unable to receive any further therapy. There were 14 documented infections, while nine patients experienced fever of unknown origin. WHO >2 nonhematological toxicity consisted of stomatitis (50%), hepatic dysfunction (11%), diarrhea (11%), and lethargy (4%). Median overall survival and disease-free survival were 6 and 13 months, respectively. Six patients are in CCR at present. We conclude that FLAG is effective in patients with AML who are relapsing after ASCT. The toxicity is acceptable, enabling most patients to receive further treatment, including second transplantation procedures. Received: October 19, 1998 / Accepted: March 30, 1999     

Allogeneic stem cell transplantation in acute myeloid leukemia: a risk-adapted approach

Allogeneic hematopoietic stem cell transplantation (alloSCT) is nowadays most frequently applied in patients with acute myeloid leukemia (AML). It combines chemoradiotherapy with immunotherapy, also known as the graft-versus-leukemia (GVL) effect. While it effectively reduces the relapse rate in patients, transplanted in remission, non-relapse mortality (NRM) may counterbalance that beneficial effect. As a result, alloSCT is generally associated with a modest gain in overall survival. Therefore, alloSCT may especially be applied in patients with a relatively high risk of relapse and a relatively low risk of NRM. Here, we discuss how recent findings that have identified and validated specific prognostic factors may affect our decision making for which category of AML-patients alloSCT may especially be indicated.     

Survival after cord blood transplantation from unrelated donor as a second hematopoietic stem cell transplantation for recurrent pediatric acute myeloid leukemia

The Japan Cord Blood Bank Network (JCBBN) reports the treatment of 22 children with acute myeloid leukemia (AML) who received umbilical cord blood transplantation from unrelated donors (CBT) as their second hematopoietic stem cell transplantation (HSCT). Provided by the JCBBN, between February 1997 and September 2006, 22 patients had CBT as a second HSCT. In the initial HSCT, eight received autologous, seven received CBT, and the remaining had allogenic BMT. At the time of CBT as a second HSCT, seven were in the second complete remission (CR2), two in the third CR (CR3), the remaining were not in remission. Reduced intensity conditioning (RIC) conducted for 10 cases and myeloablative conditioning (MAC) for 12 cases. The overall survival rate was 31.3%, 5 years after CBT. Second complete remission at second transplantation was favorable prognosis (58.3 ± 18.6%, compared with 17.1 ± 10.8% for the non-CR group. Mortality after CBT as a second HSCT accounted for 15 cases, 8 from treatment-related mortality. In conclusion, CBT combined with RIC as second HSCT may be useful against a recurrence of AML in children after the initial HSCT.