自体骨髓移植治疗急性髓性白血病

目的 :探讨急性髓性白血病患者自体骨髓移植前用 ACE方案预处理 (阿糖胞苷 +环磷酰胺 +鬼臼乙叉苷 )和全身照射 +ACE预处理的疗效。方法 :自体骨髓移植治疗 3例急性髓性白血病 ,1例采用 ACE方案预处理 ,2例用 TBI+ACE方案预处理。结果 :3例均移植成功 ,白细胞≥ 1.0×10 9/L 的时间分别为 +16天 ,+14天 ,+19天 ,血小板 >2 0× 10 9/L 的时间分别为 +17天、+19天、+19天。ACE方案预处理的并发症明显少于全身照射 +ACE预处理。结论 :单用 ACE预处理不影响自体骨髓移植疗效 ,且没有全身照射的毒副作用     

自体骨髓移植治疗急性白血病4例临床疗效观察

目的：探讨自体骨髓移植治疗急性白血病临床疗效。方法：对4例急性白血病完全缓解6个月～8个月内的患者行ABMT治疗。结果：治疗后骨髓重建时间为34d～46d,平均38d仍处于完全缓解,生活正常。结论：ABMT是治疗急性白血病、淋巴瘤及部分实体瘤有效手段之一。     

自体骨髓移植(ABMT)治疗急性白血病(附18例报告)

18例急性白血病(急非淋白血病15例、急淋白血病3例)经全身照射(TBI)及环磷酰胺(CTX)预处理后回输4℃复方氯化钠液保存56—60小时的自身骨髓。ABMT 主要采用了以下的主要措施:全环境保护、预防用抗菌素、TBI 肺部剂量6.7Gy(5.8～7.2Gy),肋骨补照4Gy、强迫性利尿及碱化尿液、静脉插管、长效维生素 B2的应用等。     

自体骨髓移植治疗复发/难治性急性白血病3例疗效观察

2001年5月-2003年3月我们对3例复发/难治的急性白血病患者进行了ABMT,取得了较好效果,现报告如下.     

自体骨髓移植治疗急性白血病合并感染4例分析

自体骨髓移植治疗急性白血病合并感染４例分析夏学鸣，林宝爵，吴德沛，张日，金正明仇红霞，常伟荣，孙爱宁，荣跃，仇惠英，陈悦书江苏省血液研究所苏州医院附属第一医院血液科（苏州·２１５００６）我院自１９８８年１２月～１９９２年１２月，采用自体骨髓移植（ＡＢ...     

自体骨髓移植治疗急性白血病和恶性淋巴瘤5例报告

自体骨髓移植（ABMT）因供髓者来源困难，现已广泛用于临床，并得到迅速发展。目前在治疗急性白血病和恶性淋巴瘤方面，在我国已成为一种重要的治疗手段。我院从1993年开始至今已完成自体骨髓移植5例，其中文例急性白血病，1例恶性淋巴瘤，现报告如下。材料和方法一、病例本组4例急性够细胞白血病（AML）均达CR。1例恶性淋巴瘤（IV期）已有骨首浸润。患者年龄12～28岁。中位年龄18岁；男性2例，女性3例。4例AML移植前在我院接受了3～4疗程的大剂量巩固强化治疗，包括阿精胞管1．sg川X3；1例恶性淋巴瘤经用COAP方案5个疗程后达CR，…     

自体骨髓移植治疗急性白血病15例临床分析

我院自1988年11月以来，利用微波净化或未净化的自体骨髓移植(ABMT)治疗急性白血病15例，取得了良好疗效。     

Autologous bone marrow transplantation in adult patients with acute lymphoblastic leukemia

Autologous bone marrow transplantation (ABMT) was introduced as a treatment for terminal leukemic relapse more than 40 years ago. For childhood acute lymphoblastic leukemia (ALL) the role of ABMT is well defined. Some studies suggest that it is also beneficial for adult patients with high-risk factors or with relapse. However, these inferences are based on a relatively small number of patients with short follow-up. Nevertheless patients with high-risk ALL are candidates for ABMT if no histocompatible sibling is available. Similarly patients in second or later complete remission (CR) in the absence of a histocompatible donor may derive benefit from ABMT. The different conditioning regimens used by the treatment centers are associated with different toxicities but none has been proven to be superior than others. In the majority of studies the marrow has been purged of leukemic cells, but this maneuver has never been evaluated in a randomized comparative trial. Transplant related mortality rate of ABMT is low compared to allogeneic transplantation. The GvL effect, which is important to eliminate malignant cells in acute and chronic myelocytic leukemia, has not been definitively demonstrated in ALL. The tyrosine-kinase inhibitor STI 571 offers new perspectives for patients with the Phl/bcr/abl translocation. It may be especially useful for treating minimal residual disease (MRD) before and/or after ABMT.     

Hematopoietic stem cell transplantation in adult acute lymphoblastic leukemia: a single-centre analysis

The role of autologous or allogeneic hematopoietic stem cell transplantation (HSCT) in ALL is controversial because of its adverse risk/benefit ratio, and the main policy is to reserve it for high-risk patients. In our Institution, between 1984 and 2002, 40 patients received an allogeneic HSCT and 39 underwent autografting. The conditioning regimen included HD-Ara-C, HD-CTX and 10 Gy fractionated TBI. After allogeneic SCT in first CR, four patients relapsed, leading to a 10-year EFS chance of 78.3%; of the other patients, 5 are still in CR. After autografting in first CR, there was an early death, one secondary AML, one death in CR and six relapses, leading to a 10-year EFS chance of 44.4%; of the other patients, 6 are still in CR. Even considering the limited number of patients and the slow accrual rate, selection bias cannot be considered a sufficient explanation for the favorable outcome of allografting in first CR as the majority of the patients had adverse prognostic factors. It cannot be claimed that allogeneic SCT was performed in patients already cured, as the autografted patients had a notably worse outcome, and a 10-year EFS chance of about 80% is an uncommon finding even in standard-risk ALL patients. It might be inferred that the timing of SCT as late intensification, in addition to a rather aggressive conditioning regimen, helped to minimize the leukemic burden, thus favoring the expression of a GVL effect. Conversely, the results in more advanced disease phases are discouraging, due to poor quality CRs and inefficacy of GVL in managing large residual disease.     

Allogeneic bone marrow transplantation in a patient with T-prolymphocytic leukemia with small-intestinal involvement

Although T-prolymphocytic leukemia (T-PLL) is characterized by organ infiltration, small-intestinal involvement is rare. We performed an unrelated allogeneic bone marrow transplantation in a patient with T-PLL who had multiple lymphomatous polyposis of the small intestine refractory to combination chemotherapy (cyclophosphamide, vincristine, and prednisolone [COP] and fludarabine plus cyclophosphamide). The patient developed no graft-versus-host disease (GVHD) and remains in complete remission 16 months after the transplantation. T-PLL is usually refractory to chemotherapy and is a T-cell malignancy with poor prognosis. There have been several reports on allogeneic hematopoietic stem-cell transplantation (allo-HSCT) for T-PLL, but none on allo-HSCT for T-PLL patients with intestinal involvement. It is suggested that allo-HSCT may improve the prognosis in patients with T-PLL involving the small intestine.     

Autologous Bone Marrow Transplantation in Acute Lymphoblastic Leukemia following In Vitro Treatment with Monoclonal Antibodies and with Complement: Analyses for Two Cases of Failure

Two children with acute lymphoblastic leukemia (ALL) receivedautologous bone marrow transplantation (BMT) using remissionbone marrow treated in vitro with the monoclonal antibodies,CD24 (BA-1), CD9 (BA-2) and CD 10 (BA-3), and with rabbit complement. In one child with second remission ALL, hematopoietic recoveryafter BMT was prompt but, 81 days after BMT, isolated centralnervous system (CNS) relapse occurred. Bone marrow relapse developedthree months later, and she died 11 months after BMT. In patientswith CNS leukemia prior to BMT, as in the present case, moreintensive pretransplant CNS treatment and/or a conditioningregimen may reduce the risk of relapse. In the other patient, with primary refractory ALL in first remission,marrow reconstitution was slower. The patient developed interstitialpneumonitis with pleural effusion, and died 54 days after BMT.No infectious causes could be detected by culture or from serologicalstudies of the pleural effusion. The rationale for applying autologous BMT to children with secondremission ALL and first remission refractory ALL is discussed.     

Rapid and complete hemopoietic reconstitution following combined transplantation of autologous blood and bone marrow cells. A changing role for high dose chemo-radiotherapy?

The role of high dose chemo-radiotherapy with autologous bone marrow transplantation in the treatment of neoplasia remains to be clearly defined. Because of the iatrogenic morbidity, mortality and high cost of the supportive care required during the post-transplantation period of prolonged marrow aplasia, intensive therapy remains a sophisticated procedure lacking proper evaluation in clinical trials. We report here that when autologous bone marrow cells are supplemented with a small number of peripheral blood nucleated cells collected after prior myelosuppressive chemotherapy, complete hematological recovery is so prompt that myeloid toxicity appears no longer the major limiting factor of high-dose chemo-radiotherapy. The increased therapeutic index made possible by the procedure will allow us to address the issue of whether intensive cytoreductive therapy can be useful as initial treatment of selected tumors with curative intent.     

Autologous bone marrow transplantation in acute leukemia.

Twenty-one cases of relapsed acute leukemia were treated with high dose piperazindione and total body irradiation followed by infusion of autologous cryopreserved remission bone marrow. Evidence for engraftment was obtained in nineteen. Eleven patients achieved complete remission; of two to fourteen months duration (median 3+). Attempts to decrease leukemic contamination of the remission bone marrow by density separation did not influence the complete remission rate and duration.     

Treatment of recurrent metastatic medulloblastoma with intensive chemotherapy and allogeneic bone marrow transplantation

We report here the first known case of a patient with recurrent metastatic medulloblastoma to achieve long-term disease-free survival following treatment with allogeneic bone marrow transplantation. A 27 year old white male with recurrent metastatic medulloblastoma involving lymph nodes, bone and bone marrow was treated with multi-agent chemotherapy followed by allogeneic bone marrow transplantation from an HLA-identical sibling donor. Morbidity was acceptable with moderate to severe mucositis in the immediate post transplant period and clinical grade I graft versus host disease of the skin controlled with modest doses of corticosteroids. The patient continues in unmaintained complete remission in excess of 28 months with a performance status of 100%. Allogeneic marrow transplantation following cytoreductive salvage chemotherapy is an aggressive strategy that may offer an improved likelihood of disease eradication and ultimate cure for poor prognosis patients with recurrent metastatic medulloblastoma.     

F1 Hybrid resistance to bn rat myelogenous leukemia parallels resistance to transplantation of normal bn bone marrow

Short-term BN bone marrow engraftment, and survival after injection of BN myelogenous leukemia were measured in three different F1 hybrid strains which had BN as one parent. The two hybrids that were resistant to BN bone marrow were resistant to BNML, while the hybrid strain that accepted BN marrow died earliest after BNML injection. The results support the hypothesis that BN bone marrow and BNML share antigens that can lead to rejection of tissue grafts. The importance of such presumptive bone marrow alloantigens in the treatment of myelogenous leukemia by bone marrow transplantation is discussed.     

Myelodysplasia and acute myeloid leukemia occurring after autologous bone marrow transplantation for lymphoma

Secondary hematopoietic disease manifesting as acute myeloid leukemia, myelodysplastic syndrome or clonal karyotypic abnormalities, has been recently recognized as a relatively frequent and potentially serious complication of autologous bone marrow transplantation for both Hodgkin's disease and non-Hodgkin's lymphoma. The available evidence suggests the disease results primarily from repeated exposure of the host stem cells to therapeutic agents before the time of transplant, but a conspiratory role for the transplantation procedure itself cannot be entirely excluded. Strategies to decrease the incidence of secondary hematopoietic disease include earlier stem cell harvest and/or transplantation, and the performance of screening karyotypic studies on the bone marrow prior to autologous grafting.     

Total body irradiation as preparation for bone marrow transplantation in treatment of acute leukemia and aplastic anemia

In an attempt to improve survival while minimizing toxicity, many bone marrow transplant centers are now studying the use of cytoreduction regimens with an increased amount of radiation in single-dose or fractionated-exposure schedules for patients with leukemia and aplastic anemia. In order to review the current results, the literature prior to September, 1982 was surveyed and data were tabulated for each transplant center regarding the number of patients receiving transplants, diagnoses, cytoreduction regimen, clinical status, remission duration, relapse rate, causes of death and incidence of interstitial pneumonia. The incidence and severity of cataracts, growth failure, hypothyroidism and second malignant neoplasms were noted, and the data obtained from the literature search were updated and expanded by telephone questionnaire when possible. Marked variation in the technique of transplantation was found among the participating institutions, making it difficult to determine the contribution of the various TBI doses, dose rates and fractionation schedules to the efficacy and toxicity of the combined regimen. In order to define the risk-benefit ratio of the various TBI regimens more clearly, prospective controlled, randomized studies will be required.