同胞异基因外周血干细胞移植治疗白血病研究

本研究观察异基因外周血干细胞移植 (PBSCT)治疗白血病的疗效与副作用。所选供者均为HLA A、B、DR位点与患者完全相同的同胞兄弟姐妹。供者经 2 5 0 μg/kgrhG CSF动员 5天后 ,单采外周血干细胞 1- 2次。 4例白血病病人经过改良Bu/Cy预处理方案 ,输入单个核细胞 6.78× 10 8/kg± 1.96× 10 8/kg( 5× 10 8/kg - 8.67×10 8/kg) ,其中CD3 4 为 15 .0 2× 10 6 /kg± 8.93× 10 6 /kg ( 5 .3× 10 6 /kg - 2 4 .2 3× 10 6 /kg) ,用MTX CsA MMF预防急性移植物抗宿主病 (aGVHD)。结果表明 :移植前 2天到移植后 2天白细胞降至最低 ,移植后 11- 17天中性粒细胞 >0 .5× 10 9/L ,移植后 11到 5 5天血小板 >5 0× 10 9/L。 4例中 2例出现aGVHD ,2例出现cGVHD ,2例出现感染。移植后 2 8天复查骨髓显示造血恢复 ,STR位点的DNA检查显示供者细胞生长。结论 :采用改良Bu/Cy方案和用MTX CsA MMF预防aGVHD方案进行PBSCT治疗白血病是一种安全、可靠的治疗方法。

Treatment of Leukemia by Allogeneic Peripheral Blood Stem Cell Transplantation from Sibling Donors

This study was aimed to observe the efficacy and side effects of allogeneic peripheral blood stem cell transplantation (Allo-PBSCT) in patients with leukemia. The donors were siblings matched with t HLA-A, B, DR loci of recipient. After mobilization with 250 microg/day rhG-CSF for 5 days, peripheral blood stem cells were collected 1 to 2 times. 4 patients with leukemia received 6.78 x 10(8)/kg +/- 1.96 x 10(8)/kg (5 x 10(8)/kg-8.67 x 10(8)/kg) peripheral blood mononuclear cells, which contained 15.02 x 10(6)/kg +/- 8.93 x 10(6)/kg (5.3 x 10(6)/kg-24.23 x 10(6)/kg) CD34(+) cells after modified Bu/Cy conditioning regimen and MTX + CsA + MMF were given for prophylaxis of aGVHD. The results showed that the leukocyte was reduced to the lowest at pretransplantation 2 days-posttransplantation 2 days. Neutrophil amount >0.5 x 10(9)/L was found at 11 - 17 day after transplantation, platelet >50 x 10(9)/L-at 11 - 55 days after transplantation. Out of 4 patients, aGVHD, cGVHD and infection took place in 2,2 and 2 cases, respectively. Bone marrow displayed hematopoietic recovery at 28 day after transplantation, examination of STR in DNA revealed proliferation of donor cells in patients. In conclusion, Allo-PBSCT in combination with modified Bu/Cy conditioning regimen and MTX + CsA + MMF prophylaxis of aGVHD is safety and reliable for treatment of leukemia.