以氟达拉滨为主的预处理行非清髓异基因造血干细胞移植17例临床观察

目的　对 1 7例血液病患者行非清髓异基因造血干细胞移植 (NAST)治疗 ,并探讨其疗效及不良反应。方法　急性髓系白血病 3例 ,慢性粒细胞白血病 (CML) 6例 ,重型再生障碍性贫血 4例 ,骨髓增生异常综合征 1例 ,非霍奇金淋巴瘤 2例 ,多发性骨髓瘤 1例。供者为其HLA配型完全相合的同胞。供者动员方案 :G CSF 30 0 μg 1 2h× 5d后分离采集外周血干细胞。输注CD3 4 +细胞数 (2 .1 5～1 0 .0 1 )× 1 0 6 kg;T细胞总数 (2 .52～ 1 0 .2 6)× 1 0 8 kg;单个核细胞数 (4.87～ 1 7.1 3)× 1 0 8 kg。预处理方案为 :氟达拉滨 30mg·m-2 ·d-1 × 6d ;白消安 4mg·kg-1 ·d-1 × 2d ;抗淋巴细胞免疫球蛋白 1 2～ 1 5mg·kg-1·d-1 × 4d ;阿糖胞苷 50 0mg d× 3d或环磷酰胺 50mg·kg-1 ·d-1 × 2d。单用环孢菌素A(CsA) 3mg·kg-1 ·d-1 预防移植物抗宿主病 (GVHD)。结果　所有患者均顺利完成预处理及移植治疗。 1 1例出现轻微黏膜炎 ,1例有血清病样表现 ,1 0例发生轻度肝功能损害 ,2例在应用CsA过程中有轻度肾功能损害。移植后出现急性GVHD和慢性GVHD各 5例 ,并发间质性肺炎 5例 ,无肝静脉闭塞症、出血性膀胱炎、白质脑病、严重的感染及出血发生。移植后第 8天 (+8天 )～ +1 9天造血重建。 1 6例患者已达完全嵌合

Seventeen cases of nonmyeloablative stem cell transplantation using conditioning regimen containing fludarabine

OBJECTIVE: To explore the efficiency and toxicity of non-myeloablative stem cell transplantation (NAST) for hematological disease. METHODS: Seventeen patients, including 3 acute myeloid leukemia, 6 chronic myelogenous leukemia, 4 severe aplastic anemia, 2 non-Hodgkin's lymphoma, 1 multiple myeloma and 1 myelodysplastic syndromes received NAST from HLA-identical sibling donors. Peripheral blood stem cells were mobilized by G-CSF 300 microg/12 hours x 5 d. (2.15 -10.01) x 10(6) CD(34)(+) cells/kg were transplanted. A non-myeloablative conditioning regimen included fludarabine 30 mg.m(-2).d(-1) x 6 d;busulfan 4 mg.kg(-1).d(-1) x 2 d or cyclophosphamide 50 mg.kg(-1).d(-1) x 2 d and antilymphocytic globulin 12 approximately 15 mg.kg(-1).d(-1) x 4 d. Cyclosporin A was used to prevent graft versus host disease (GVHD) alone and no G-CSF was administered after NAST. RESULT: Hematopoiesis reconstitution resumed on day 8 to day 19 (average of day 13). Severe mucositis was absent. Hepatic venoocclusive disease did not occur. Infectious complications were rare. Acute and chronic GVHD each occurred in 5 patients. Idiopathic pneumonia was developed in 5 patients. In the follow-up duration of 120 to 425 days, 16 of the 17 cases had a stable mixed or complete chimerical states. Fourteen of 17 patients are alive. CONCLUSION: NAST is an effective therapy in the treatment of hematological diseases with less complications, less blood transfusion and lower cost.