摘要
目的探讨异基因外周血造血干细胞移植（HSCT）治疗急性白血病的临床疗效和移植相关并发症情况。方法选取2008年2月—2014年2月在血液科行异基因外周血HSCT术治疗的急性白血病患者45例为研究对象，其中急性髓系白血病患者24例，急性淋巴细胞白血病患者19例，慢性粒细胞白血病加速期急变期患者各1例。患者预处理采用经典静脉马利兰（Bu）＋环磷酰胺（cy）方案，人白细胞抗原（HLA）不全相合患者给予阿糖胞苷＋BuCy（Ara-C＋BuCy）预处理，疑有中枢累及患者加用司莫司汀胶囊（Me-CCNU）处理。移植物抗宿主病（GVHD）患者预防采用环孢素A＋短程甲氨蝶呤（MTX）＋霉酚酸酯（MMF）处理，HLA不全相合患者加用ATG（即复宁）处理。治疗后，随访至2014年2月，对患者的治疗情况进行统计。结果45例患者均获得完全植入，获造血重建。随访至2014年2月28日，患者中位生存时间19（2～63）个月，患者死亡10例，其中复发死亡4例，GVHD死亡4例，继发第二肿瘤（非霍奇金淋巴瘤）1例，颅内出血死亡1例，其余均随访至今，其中3年无病生存6例。结论随着HLA配型技术、移植相关并发症的预防和支持治疗的进展，异基因HSCT将成为恶性血液病安全有效的治疗方法。
Objective To study the clinical curative effect and complications of ailogeneic peripheral blood hematopoietic stem cell transplantation（HSCT） in the treatment of acute leukemia. Methods From February 2008 to February 2014, allogeneic peripheral blood hematopoietic stem cell transplantation was used in our department to treat 45 cases of patients with acute leukemia, including 24 cases of acute myeloid leukemia, 19 cases of acute lymphoblastic leukemia, 1 case of ac- celerated phase chronic myelogenous leukemia and 1 case of blastic phase chronic myelogenous leukemia. Bu and Cy were used as conditioning regimen for HSCT, Ara-c ＋ Bu/Cy was used for HLA-haploidentical/mismatch donors, and additional Me-CCNU for patients with suspected central nerve involved. The graft versus host disease（GYHD） was prevented by u- sing Ciclosporin A ＋ short-course methotrexate （MTX） ＋ mycophenolate mofetil （ MMF）, and additional antithymocyte globulin（ATG） for HLA-haploidentical patients. After the treatment, patients were followed up to February 2014 and the outcome was evaluated. Results All the 45 patients were implanted completely, with hematopoietic reconstruction, and the median survival time was 19 months（2 -63 months）. There were 10 cases of death,4 cases died for recurrence,4 ca- ses died for GYHD, secondary tumor（ non-hodgkin＇ s lymphoma） in 1 case ,2 intracranial hemorrhage in 1 case death, and the rest were followed up to now,and 3 year disease-free survival in 6 cases. Conclusion As the development of HLA match technology, transplantation related complications prevention and supporting treatment, allogeneic hematopoietic stem cell transplantation will become a safe and effective treatment method for hematologic malignancies.
出处
《中华全科医学》
2016年第1期41-43,共3页
Chinese Journal of General Practice
关键词
急性白血病
异基因
干细胞移植
疗效
Acute leukemia
Allogene
Stem cell transplantation
Curative effect
