异基因外周血干细胞移植治疗急性和慢性白血病52例临床观察

目的:评价异基因外周血干细胞移植(Allo-PBSCT)治疗血液肿瘤的疗效。方法:用Allo-PBSCT治疗血液肿瘤患者52例急性淋巴细胞白血病(ALL)11例,急性髓系白血病(AML)12例,慢性粒细胞白血病(CML)29例]。预处理方案为含TBI(21例)与不含TBI的高剂量化疗方案(31例),采用环孢素加骁悉加甲氨喋呤(MTX)常规预防性控制移植物抗宿主病,非亲缘关系移植加用抗胸腺细胞球蛋白(ATG)。结果:52例患者移植后造血功能均重建,急性移植物抗宿主病(aGVHD)发生率23.1%,慢性移植物抗宿主病(cGVHD)发生率21.2%,其中局限型占15.4%;9例患者于移植后1～16月分别死于移植物抗宿主病、感染和疾病复发或进展,35例患者已PFS3～46个月,ALL-首次完全缓解(CR1)9例,无病存活(DFS)5例,带病生存2例,死亡2例,ALL-不缓解(NR)2例,死亡2例;AML-CR18例,DFS6例,带病生存2例,AML-CR24例,DFS2例,带病生存1例,死亡1例;CML(慢性期)22例,DFS19例,带病生存2例,死亡1例,CML(加速期)4例,DFS2例,带病生存1例,死亡1例,CML(急变期)3例,DFS1例,死亡2例。结论:异基因外周血干细胞移植是目前有可能治愈血液肿瘤的惟一方法。CML慢性期和急性白血病CR1后尽早选择异基因造血干细胞移植。

Allogenetic peripheral blood stem cell transplantation for patients with acute/chronic leukemia: clinical observation in 52 cases

Objective:To evaluate the therapeutic effect of allogenetic peripheral blood stem cell transplantation (Allo-PBSCT) for acute/chronic leukemia.Methods:Fifty-two patients (ALL in 11 cases,AML in 12 cases,CML in 29 cases) received Allo-PBSCT following conditioning regimens with TBI in 21 cases or high dose chemotherapy without TBI in 31 cases. Prophylactic preventing graft-versus-host disease (GVHD) was adopted with cyclosporine A (CsA)/mycophenolate mofetil (MMF)/methotrexate (MTX) and additional ATG for unrelated-donor PBSCT.Results:All patients obtained hematopoieteic reconstitution. The incidence rate of Acute GVHD was 23.1%,and chronic GVHD was 21.2% (limited 15.4%). Nine patients died of GVHD,infection,disease relapse or development,and thirty-five patients were disease-free survival (DFS) from 3 to 46 months. Of patients,9 was ALL-CR1(first time CR):5 in DFS,2 in live with disease(LWD),2 in death; 2 was ALL-NR:2 in death; 8 was AML-CR1:6 in DFS,2 in LWD; 4 was AML-CR2 (second time CR):2 in DFS,1 in LWD,1 in death; 22 was CML(chronic phase):19 in DFS,2 in LWD,1 in death; 4 was CML (accelerated phase):2 in DFS,1 in LWD,1 in death; 3 was CML (acute transformation phase):1 in DFS,2 in death.Conclusion:Allo-PBSCT is an only effective approach for the cure of patients with acute/chronic leukemia. It is strongly recommended that CML (chronic phase) and AL-CR1 adopt Allo-PBSCT therapy as soon as possible.