异基因外周血造血干细胞移植治疗急性单核细胞白血病的临床观察

目的评价异基因外周血造血干细胞移植（allo-PBSCT）治疗急性单核细胞白血病（M5）的疗效,并探讨其并发症的预防及处理。方法 16例M5患者接受allo-PBSCT,其中亲缘11例,非亲缘5例。预处理方案：9例采用清髓方案BUCY,7例采用非清髓方案FBC。亲缘的11例均采用环孢素＋短程甲氨蝶呤预防移植物抗宿主病（GVHD）,非亲缘的5例均采用环孢素＋甲氨蝶呤＋吗替麦考酚酯＋ATG。输注的外周血干细胞有核细胞中位数为6.58×108/kg,CD34＋细胞中位数为4.46×106/kg。结果 16例患者中15例均证实植活,余1例在移植早期因HVOD死亡。植入病人中白细胞植入中位时间为13（9~17）d,血小板〉20×109/L的中位时间为16（8~26）d。发生急性GVHD 6例（Ⅰ度4例,Ⅱ度2例）,发生局限性慢性GVHD 7例。目前无病存活10例,中位生存期为45（3~78）个月。结论 Allo-PBSCT是治疗M5的有效手段,并发症少,能有效延长患者生存时间。

A clinical observation of allogeneic peripheral blood hematopoietic stem cells transplantation for acute monocytic leukemia

Objective To study the therapeutic effectiveness and associated complications of allogeneic peripheral blood stem cells transplantation（Allo-PBSCT） in treatment of acute monocytic leukemia（M 5）.Methods Sixteen patients with acute monocytic leukemia received allo-PBSCT,11 patients received PBSCT from human leucocyte antigen（HLA）-matched sibling donors and 5 from HLA-matched unrelated donors.Pre-Processing regimen： 9 patients were subjected to modified BU / CY2 regimen which was myeloablative,another 7 patients were subjected to FBC regimen which was non-myeloablative.The graft-versus-host disease（GVHD） was prevented by cyclosporin A（CsA）,short-term methotrexate（MTX） in 11 patients who received PBSCT from HLA-matched sibling donors,and another 5 patients additionally received antithymocyte globulin（ATG） and mycophenolate mofetil（MMF）.A median of 6.58 × 108/ kg nucleated cells and 4.46 × 106/ kg CD34＋cells were transfused.Results Except for 1 patient died early after transplantation because of hepatic veno-occlusie disease（HVOD）.Other 15 patients achieved engraftment confirmed by blood type,chromosome test and DNA polymorphism,with median times of neutrophil 0.5 × 109/ L and platelet 20 × 109/ L being 13（9 ~ 17） d and 16（8 ~ 26） d respectively.Six patients developed acute GVHD（4 developed grade Ⅰ and 2 developed grade Ⅱ）.Seven patients experienced local chronic GVHD.Ten patients were found to have disease-free survival（DFS）,median of 45（3 ~ 78） months.Conclusion Allo-PBSCT was an effective therapy for acute monocytic leukemia,it was safe and feasible,and long term survival was hoped for patients of this type.