异基因外周血造血干细胞移植联合骨髓移植治疗白血病30例

 目的　观察异基因外周血干细胞移植联合骨髓移植对白血病的疗效。方法　白血病患者30例，平均年龄32.6岁，其中急性髓细胞白血病（AML） 11例，急性淋巴细胞白血病（ALL） 14例，慢性粒细胞白血病（CML）5例，供者均为HLA相合同胞，动员方案为每天G-CSF 5 μg／kg，共5 d，并于外周血干细胞回输当天采集供者骨髓300 ml回输；预处理方案采用Bu／Cy，移植物抗宿主病（GVHD）预防采用环孢素A（CsA）联合甲氨蝶呤（MTX）、吗替麦考酚酯（MMF）。结果　回输外周血单个核细胞（5.13±2.6）×108／kg，骨髓单个核细胞（1.3±0.6）×108／kg，30例患者均成功植活，其中中性粒细胞＞0.5×109／L的时间为（12.1±3.25）d，血小板＞0.5×109／L的时间为（14.0±5.33）d；Ⅰ～Ⅱ度aGVHD发生率为40.0 %（12／30），Ⅲ～Ⅳ度发生率3.3 %（1／30），cGVHD发生率为43.3 %（13／30），严重cGVHD发生率为3.3 %（1／30）；2年无病生存率达72.0 %。结论　异基因外周血造血干细胞移植联合骨髓移植是治疗白血病的有效方法，并有可能减少重度急、慢性GVHD的发生。

Allogeneic peripheral blood stem cell transplantation combined with bone marrow transplantation for malignant hematologic diseases

Objective To observe curative effect and clinical outcome in 30 recipients undergoing allogcneic peripheral blood stem cell transplantation (PBSCT) combined with bone marrow transplantation (BMT). Methods 30 patients with a median age of 32.6 years underwent allo-HSCT, of which 11 patients with AML, 14 patients with ALL, and 5 patients with CML They all have a HLA-identical sibling. PBSCswere mobilized with G-CSF. Three hundreds milliliter bone marrow blood was transplanted to the patients on the day that the PBSC was transplanted. Amended Bu/Cy was used as the conditioning regimen. MTXcombined with CsA and MMF was used as GVHD prophylaxis. Results A median number of mononuclear cells of (5.13±2.6)x10~8/kg recipient's weight was collccted from peripheral blood, and (1.3±0.6)x10~8/kgrecipient' s weight from bone marrow blood. Engraftment of neutrophils and platelets was achieved at a median of (12.1±3.25) days and (14±5.33) clays respectively. Ⅰ - Ⅱ acute GVHD occurred in 40.0 % cases,Ⅲ - Ⅳ acute GVHD occurred in 3.3 % cases, and chronic GVHD developed in 43.3 % cases. Severe cGVHD developed in 3.3% cases. The 2 years disease free survival rate (DFS) by the day of transplantation was 72.0 %. Conclusion PBSCT combined with BMT was effective to cure leukemia. The results also suggested that PBSC recipients had an lower incidence of aGVHD and cGVHD as compared with previous reports.