低剂量全身照射在非清髓性干细胞移植中的临床研究

目的 观察非清髓性低剂量全身照射的临床效果和急性毒副作用。方法 2006年1月至2008年1月对27例异基因造血干细胞移植患者采用含有全身照射的非清髓预处理方案:全身照射(TBI)2 Gy,一次完成;受者原发病不同,受者机体状态、年龄、脏器功能以及供受者HAL相合情况等不同,使用的化疗方案也有不同,包括氟达拉宾、环磷酰胺、阿糖胞苷、马法兰等。预防移植物抗宿主病(GVHD)采用:环孢霉素、霉酚酸酯。结果 造血重建情况: 27例均于移植后第4~8天外周血WBC降至(0.05~0.9)×10⁹/L。中性粒细胞计数>0.5×10⁹/L为8~22 d(中位数为10.5 d),血小板计数>30×10⁹/L为11~28 d(中位数为14.5 d)。1、2年生存率为85.2%(23/27)、77.8%(21/27)。发热率65%,10例发生感染。无出血性膀胱炎和肝静脉闭塞症等并发症。急性GVHD 4例(15%), 慢性GVHD 5例(19%)。随访3~22个月21例(77.8%)仍存活。结论 采用低剂量全身照射的非清髓性造血干细胞移植预处理方案简便安全,并发症少,适应证广;全身照射总剂量2 Gy,1次完成的方案是安全有效的,可以达到免疫抑制效果。

Clinical trial of low-dose whole body irradiation in the non_myeloablative hematopoietic stem cell transplantation

Objective To observe the efficacy and acute toxicity in non-myeloablative low-dose tatal body irradiation. Methods From January 2006 to January 2008, 27 cases of hematopoietic stem cell transplantation patients received non_myeloablative pretreatment program involving low-dose whole body irradiation. Pretreatment program: the total dose of TBI was 2 Gy, once completely. According to primary disease, physical condition, age, organ function and HAL coincide situation, the patients received different chemotherapy, including FUL, CTX, Ara-C, melphalan and so on. To prevent the graft-versus-host disease (GVHD), CSA/MMF was used. Results Hematopoietic reconstruction: the peripheral blood WBC in all 27 cases reduced to (0.05-0.9)×10⁹/L in 4 to 8 days, with the neutrophil count>0.5×10⁹/L in 8 to 22 days (median+10.5 days), the platelet count> 30×10⁹/L in 11 to 28 days (median+14.5 days). The transplant rate was 85.2% (23/27). The fever rate was 65% and the infection rate was 37%(10/27). Hemorrhagic cystitis,hepatic veno-occlusive disease (HVOD),and other complications did not occurred. 4 cases developed aGVHD (15%) and 5 cases developed cGVHD (19%) out of 27 cases. Follow-up 3 to 22 months, 21 cases are still alive(77.8%).Conclusion Pretreatment with low-dose whole body irradiation of non-myeloablative hematopoietic stem cell transplantation proved to be simple and safe with fewer complications and broad indications. Program of TBI with total dose of 2 Gy (once completely) is a safe, less toxic and effective method. It could achieve the effectiveness of immune suppression.