大剂量化疗不加全身放疗行自体骨髓移植治疗急性髓细胞性白血病

本文报告9例急性髓细胞性白血病在首次缓解期单用大剂量化疗不加全身放疗(TBI)行未净化自体骨髓移植(ABMT)治疗,经远期随访观察,结果有4例(44.4%)移植后分别已无病存活36、39、44和58个月,另5例(55.6%)则在移植后3.5～12.5个月时死于白血病复发。     

自体骨髓移植结合强烈化疗治疗急性白血病疗效观察

为探讨减少自体骨髓移植（ABMT）后复发率和延长无病生存期。作者采用ABMT结合强烈化疗的方法治疗急性白血病。能列入统计的12例患者中,8例移植后已持续完全缓解19～79个月,中位数58.5个月。证明采用ABMT结合强烈化疗方法,可以减少急性白血病的复发率和延长无病生存期。     

Bone Marrow MicroRNA-335 Level Predicts the Chemotherapy Response and Prognosis of Adult Acute Myeloid Leukemia

The aim of this study was to investigate the role of microRNA-335 (miR-335) in determining the treatment response and prognosis in adult acute myeloid leukemia (AML) patients receiving the cytarabine (Ara-C)-based chemotherapy.A total of 204 adult AML patients were collected. The miR-335 levels in serum and bone marrow samples from these patients were determined. All patients received Ara-C-based standard induction chemotherapy regimens. The treatment response to Ara-C-based chemotherapy was evaluated. All patients were followed for prognostic analyses.The levels of miR-335 in bone marrow and serum samples from adult AML patients achieving complete response were significantly higher than those without. The serum miR-335 level was not associated with the chemotherapy response and prognosis in these AML patients. In contrast, high bone marrow miR-335 level was significantly associated with a poor treatment response and also predicted a worse prognosis indicated by the relapse-free survival and overall survival periods in adult AML patients receiving Ara-C-based chemotherapy.Our finding suggests that bone marrow miR-335 level may be used as a marker to predict the chemotherapy response and prognosis in adult AML patients.     

Glanzmann Thrombasthenia with Acute Myeloid Leukemia Successfully Treated by Bone Marrow Transplantation

We report successful treatment by bone marrow transplantation (BMT) in an acute myeloid leukemia (AML) patient with Glanzmann thrombasthenia (GT). Genetic analysis revealed that a novel point mutation in exon 3 of the GPIIb gene led to abnormal splicing resulting in an amino acid substitution and an in-frame deletion of 3 amino acid residues. Expression studies suggested a rapid degradation of the uncomplexed protein within the cells. Induction therapy for AML was performed with frequent platelet transfusions because of the patient's severe hemorrhagic manifestations. In the second remission, the patient was successfully treated by BMT from an HLA-matched unrelated donor. Platelet function returned to normal, and the GT phenotype completely disappeared. Our experience suggests that BMT is a curative therapeutic strategy for GT. Furthermore, we believe this study is the first to demonstrate that engraftment after BMT for AML can be determined by monitoring the congenital genetic defect of GT.     

慢性髓细胞性白血病骨髓移植后细胞遗传学动态观察

本文报道12例慢性髓性白血病(CML)患者骨髓移植(BMT)后染色体系统的追踪概况。BMT后三种核型:1.完全供者细胞;2.正常供者/受者或供者/受者Ph(+);3.正常供者/受者/受者Ph(+)细胞。BMT后1例病人复发,染色体伴有附加异常+(18,21)、t(4;15)、b13q、15q~+、8q~+。附加异常为研究移植后细胞遗传学能否帮助新型染色体核型及与复发的关系有重要意义。     

rIL2／LAK细胞净化的自体骨髓移植治疗白血病

用ｒＩＬ２和自体外周血克隆化ＬＡＫ细胞体外二步净化白血病髓后行ＡＢＭＴ，移植后体内再用ｒＩＬ２／ＬＡＫ细胞治疗；４例行ＡＢＭＴ白血病病人用ｒＩＬ２／ＬＡＫ细胞体内外净化后，２例对化疗无效的病人获ＣＲ，４例病人移植后至１９９４年９月持续缓解８－１４月，移植后第３周末测定外周血ＮＫ细胞活性明显高于另３例未净化行ＡＢＭＴ白血病病人；ｒＩＬ２／ＬＡＫ细胞体外二步净化骨髓不影响ＣＦＵ－ＧＭ回收率，移植后不曩     

自体骨髓移植治疗成人恶性淋巴瘤后的长期随访

1983年至1991年我们用高剂量长春新碱、阿糖胞苷、环已亚硝脲及环磷酰胺加全淋巴(身)照射[Hd-VCCA+TL(B)I]和自体骨髓移植(ABMT)治疗了21例中高危组成人恶性淋巴瘤患者。其中5例为晚期,6例为耐药复发,4例为部分缓解(PR),4例为首次缓解(CR_1),2例为第二次缓解(CR_2)。平均随访37个月,9年生存率在何杰金氏淋巴瘤(HL)和非何杰金氏淋巴瘤(NHL)分别预期为89%和64%,提示该方案毒性反应可以耐受。如果在患者病程早期进行,可使约70%的成人恶性淋巴瘤患者长期存活。同时提示对骨髓受累或原淋巴细胞型的患者在移植前应作适当的净化残留肿瘤细胞的处理。     

急性髓性白血病骨髓组织学分型的研究

目的：探讨塑料包埋骨髓活检切片对急性髓性白血病（AML）进行组织学分型的可能性。方法：对92例初诊AML患者的骨髓切片进行常染色观察。结果：5例属增生减退型，87例为增生活跃型。43例分入白血性原始细胞的纯一性浸润型，另49例为非纯一性浸润型。内59例为纤维增生型，33例分入非纤维增生型AML。结论在AML的分型中，活检切片对涂片有补充与纠正作用。     

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。     

Successful Allogeneic Bone Marrow Transplantation in a Patient with Acute Myelogenous Leukemia and Cytomegalovirus Retinitis

A 1-year-old boy with acute myeloid leukemia with cytomegalovirus (CMV) retinitis that was refractory because of severely impaired cellular immunity underwent bone marrow transplantation from an HLA-matched donor after a conditioning regimen of busulfan, cyclophosphamide, and etoposide. Although we continued administration of ganciclovir from preparation therapy, retinitis worsened after engraftment. Thereafter retinitis improved gradually as the number of CD4+ T-lymphocytes increased. The findings in this case suggest that stem cell transplantation for a leukemia patient with CMV disease may be effective.     

Transplantation of HL-A Identical Allogeneic Bone Marrow to a Patient With Acute Lymphocytic Leukemia

An 8-year-old boy with acute lymphocytic leukemia, no longer responsive toconventional chemotherapy after 2 years,was successfully grafted with bone marrow from his HL-A genotypically identical 10-year-old sister. Prior to transplantation, he had received 141 bloodcomponent transfusions and had becomesensitized to histocompatibility antigens(HL-A), as demonstrated by the presenceof circulating lymphocytotoxic antibodies.Except for the occurrence of a possiblemild graft-versus-host-reaction and a documented cytomegalovirus infection, thepatient remained clinically well until fullreturn of his leukemia 91 days after thetransplant. This case demonstrates thatbone marrow transplantation can be accomplished between HL-A identical siblings even though the recipient may havebeen previously sensitized to other HL-Aantigens by earlier transfusion. Allogenicbone marrow transplantation offers theopportunity for remissions in patientswith leukemia unresponsive to conventional drug therapy.

Submitted on May 25, 1970 Revised on July 15, 1970 Accepted on July 16, 1970