异基因外周血造血干细胞移植治疗白血病(附50例临床报告)

目的:评价异基因外周血造血干细胞移植(Allo-PBSCT)治疗白血病的疗效,同时比较ABO血型相合与不相合移植以及两种移植物抗宿主病(GVHD)预防方案.方法:用Allo-PBSCT治疗白血病50例(急性29例,慢性21例),其中ABO血型相合30例,不相合20例.PBSC动员采用G-CSF或G-CSF+GM-CSF皮下注射5 d;预处理采用CTX+VP16+TBI或CTX+TBI方案;GVHD预防采用常规环孢素A(CsA)+短程甲氨蝶呤(MTX)和霉酚酸酯(MMF)联合CsA+短程MTX两种方案.结果:本组患者经Allo-PBSCT均获得造血功能重建.ABO血型相合移植与不相合移植比较,后者血红蛋白恢复较慢(P<0.05),中性粒细胞和血小板恢复两者无差异(P>0.05).本组发生aGVHD 20例(40%),其中Ⅱ度以上9例(18%).生存6个月以上者发生cGVHD 22例(66.67%),其中广泛性11例(33.33%).MMF联合CsA和MTX方案与常规CsA联合MTX方案相比,前者可减少aGVHD发生率(P<0.05),虽两者cGVHD总发生率无差异(P>0.05),但前者广泛性cGVHD明显减少(P<0.05);本组患者中位随访30个月存活33例,移植后3年无病生存率为66%;GVHD合并感染和间质性肺炎是主要死因.结论:ABO血型不合不影响移植,但移植后血红蛋白恢复较慢;Allo-PBSCT中aGVHD发生率并不高,但cGVHD发生率明显升高;MMF联合CsA和MTX方案预防GVHD较常规CsA联合MTX方案为优.

Allogeneic peripheral blood stem cell transplantation in treatmemt of leukemia: A report of 50 cases

Objective:To evaluate the efficacy of allogeneic peripheral blood stem cell transplantation (Allo-PBSCT) in the treatmemt of leukemia.Methods: Twenty-nine patients with acute leukemia and 21 patients with chronic leukemia were treated with Allo-PBSCT. ABO blood types were matched in 30 patients and mismatched in 20 patients. PBSC were mobilized with G-CSF or G-CSF+GM-CSF for 5 d. Conditioning regimens included standard TBI plus CTX or TBI plus CTX and VP16. Two regimens were used for prophylaxis of graft-versus-host disease (GVHD), one was the traditional combination of low dose cyclosporine(CsA) and short course methotrexate(MTX)(CsA/MTX group), the other was short course mycophenolate mofetil(MMF)besides CsA and MTX(MMF/CsA/MTX group). Results: All patients were successfully engrafted. Hemoglobin recovery (to 80 g/L) was significantly slower in ABO mismatched patients (median 52 d) than matched patients (median 14 d)(P<0.05), and there was no significant difference in the recovery of granulocyte and platelet (P>0.05). The incidence of aGVHD was 40% (20/50) with grade Ⅱ-Ⅳ 18%(9/50). cGVHD occurred in 22 of 33 patients (66.67%) lived longer than 6 months post-transplantation, and 11 of them were with extensive cGVHD (33.33%). The incidence of aGVHD in MMF/CsA/MTX group (16.67%) was significantly lower than that of CsA/MTX group (53.13%)(P<0.05). Although the incidence of cGVHD was the same in 2 groups (P>0.05), the incidence of extensive cGVHD was lower in MMF/CsA/MTX group (9.09%) than that of CsA/MTX group (45.45%) (P<0.05).The median follow-up period was 30 months. The 3 year disease-free-survival (DFS) was 66%. GVHD, infection and interstitial pneumonitis were the main causes of death. Conclusion: Allo-PBSCT is a safe and effective therapy for leukemia. The MMF/CsA/MTX regimen for prevention of aGVHD is more efficient than CsA/MTX.