双次自体造血干细胞移植治疗恶性血液病的临床分析

目的　分析双次自体造血干细胞移植 (DAHSCT)治疗恶性血液病的临床疗效。方法　对 19例恶性血液病患者在确诊后 1年内进行第 1次自体造血干细胞移植 ,以足叶乙甙或阿糖胞苷 +环磷酰胺 +分次全身照射进行预处理 ,其中 9例加用卡氮芥 ;第 1次自体造血干细胞移植术后 4～ 10个月进行第 2次自体造血干细胞移植 ,预处理方案为足叶乙甙或阿糖胞苷 +环磷酰胺 +马法兰。结果　所有患者两次移植后均获造血重建 ,第 1次自体造血干细胞移植的造血重建速度快于第 2次 ,无1例移植相关死亡。中位随访时间 10 78(5 79～ 382 1)d ,存活 12例 (6 3 2 % ) ,复发、死亡 7例 (37 5 % ) ,DAHSCT后 3年无病生存率为 6 3%± 10 % ;其中急性白血病患者第 2次移植时骨髓原始幼稚淋巴细胞或原始粒细胞百分比高于第 1次移植的患者易于复发。结论　DAHSCT移植患者相关死亡率低 ,无病生存率较高 ,可作为恶性血液病治疗的重要方法

An analysis of double autologous hemopoietic stem cell transplantation for hematological malignancies

OBJECTIVE: To analyse the clinical efficacy of the double autologous hemopoietic stem cell transplantation (DAHSCT) for hematological malignancies. METHODS: 19 hematological malignant disease patients received the first AHSCT within 12 months after diagnosis. The first conditioning regimen was VP-16 or Ara-C, CTX +, TBI, nine of them received BCNU additionally. All patients received the second AHSCT in 4 to 10 months after the first AHSCT. The second conditioning regimen was VP-16 (or Ara-C), CTX +, Mel. RESULTS: All patients had rapidly hemopoietic reconstitution, the first hemopoietic reconstitution is faster than the second. There was no AHSCT related death. The median follow up duration was 1078 days. 12 of the 19 patients were still alive during the analysis. The 3-year disease-free suvival (DFS) was 63% +/- 10%. Those patients who had more blasts in bone marrow at the second AHSCT than the first AHSCT had greater probability to relapse. CONCLUSION: DAHSCT can be safety performed as an important treatment method in hematological malignancies.