利妥昔与DC-CIK治疗ALL患儿的疗效及预后影响分析

目的 研究利妥昔配合DC-CIK治疗儿童前体B型急性淋巴细胞白血病（ALL）的疗效及不良反应,重点分析利妥昔对DC-CIK治疗后的影响。方法 回顾分析2006年6月—2012年6月四川省遂宁市中心医院50例CD20阳性的ALL患儿,分为对照组和观察组,每组25例。对照组采用化疗配合DC-CIK治疗;观察组采用利妥昔、化疗和DC-CIK联合治疗的方法。比较两组患儿治疗后的临床疗效及不良反应,并统计随访中两组患儿的3年无事件生存率。结果 治疗后两组患儿Per2、Bmal1及EVI1 mRNA比较,差异有统计学意义（P?<0.05）,表达下降,且观察组低于对照组。观察组与对照组比较,治疗后临床疗效略好,但其不良反应较多。观察组患儿3年无事件生存率高于对照组。结论 利妥昔配合DC-CIK治疗疗效更佳,利妥昔对DC-CIK预后有促进作用,但其治疗后副作用较多且费用较高。     

单倍体造血干细胞移植治疗白血病23例

BACKGROUND:Allogeneic hematopoietic stem cell transplantation (HSCT) is one of the effective methods in the treatment of leukemia. The haploidentical HSCT is an option for the patients who need a HSCT without a human leukocyte antigen (HLA)-matched donor. OBJECTIVE:To study the clinical efficacy of HLA-haploidentical HSCT on leukemia and its complications. METHODS:A total of 23 patients (4 cases of acute lymphoblastic leukemia, 12 of acute myelogenous leukemia, and 7 of chronic granulocytic leukemia) who had been treated with HLA-haploidentical HSCT from November 2007 to March 2015 were enrolled. Conditioning regimen I was set as cyclohexyl nitrosourea+cytarabine+busulfan+cyclophosphamide; regimen II as cyclophosphamide+total body irradiation; regimen III as fludarabine+cytarabine+busulfan+cyclophosphamide; and regimen IV as busulfan+cyclophosphamide. Cyclosporin A, mycophenlate mofetil, antithymocyte globulin and methotrexate were used to prevent graft-versus-host disease (GVHD). Hematopoietic remodeling, complications and prognosis were observed in all patients undergoing HLA-haploidentical HSCT. RESULTS AND CONCLUSION:Of the 23 patients, 22 achieved reconstitution of the granulocyte series, and 19 achieved reconstruction of the megakaryocyte series. Additionally, there were 7 cases of acute GVHD and 4 of chronic GVHD. Transplant-related mortality was 22% (5/23) within 100 days post transplantation including graft failure, acute GVHD, intracranial hemorrhage and disseminated infections. There were 14 cases of disease-free survival from 100 days to 24 months post transplantation, 2 cases of death due to GVHD and fungal infection, or recurrence and chronic GVHD, and 2 cases of recurrence under treatment. These findings indicate that HLA-haploidentical HSCT is an effective approach for the treatment of patients with leukemia, which is worth further investigation in clinical practice.