摘要
目的探讨采用全身照射（TBI）预处理方案行人类白细胞抗原（HLA）配型不相合亲缘供者非去T异基因造血干细胞移植（allo-HSCT）治疗白血病的疗效。方法2002年4月至2007年1月北京大学血液病研究所8例采用TBI预处理方案行HLA不合非去T亲缘供者allo-HSCT的白血病患者，其中急性髓性白血病（AML）3例，急性淋巴细胞性白血病（ALL）4例，慢性粒细胞白血病1例；预处理方案采用TBI加环磷酰胺（CY）方案4例，TBI加氟达拉滨（FLU）方案4例；干细胞来源包括骨髓和外周血造血干细胞移植6例，外周血造血干细胞移植（PBSCT）2例；移植物抗宿主病（GVHD）预防采用经典的环孢素A（CsA）＋霉酚酸酯（MMF）＋短程甲氨蝶呤（MTX）方案。结果8例供者采集单个核细胞（MNC）中位数为7.39（6.27～12.46）×10^8／kg，粒细胞植入中位时间11（11～13）d，血小板植入中位时间13（11～21）d。5例发生Ⅰ～Ⅱ度急性GVHD，2例出现慢性广泛性GVHD，无严重急性GVHD或因GVHD死亡病例。中位随访时间9（3～53）个月，除1例复发存活外，其余病例无病存活。结论对于HLA不相合异基因造血干细胞移植，TBI方案是一种比较安全、有效的非去T预处理方案，对于高危和二次移植患者同样有效。
Objective To explore the feasibility of HLA mismatched hematopoietic stem cell transplants with conditioning regime containing TBI for the treatment of leukemia. Methods Between April 2002 and January 2007, eight patients received hematopietic stem cell transplants（HSCT）with HLA mismatched family donors,including 1 chronic monomyelocytic leukemia（CMML） ,3 acute nonlymphocytic leukemia（ANLL） ,and 4 acute lymphocytic leukemia（ALL）. Stem cell sources were G-CSF mobilized peripheral blood（ n =2）or bone marrow plus peripheral blood（n=6）. Four patients were conditioned with TBI and cyclophosphamide （CY） , the other four patients were conditioned with TBI and fludarabine （FLU）, of whom 7 were conditioned with additional antithymocyteglobulin（ATG） , and 1 was conditioned with additional CD25 antibody. Graft versus host disease （GVHD）prophylaxis regimen consisted of cyclosporin A （CSA）and methotrexate （MTX） and mycophenolate mofetil （MMF）. Results Eight patients received a mean number of 7.39 （6.27～12.46 ） × 10^8/kg MNC from donor stem cell. The mean time of ANC〉0.5 × 10^9/L was day 11 （ 11 ～ 13 ）, and BPC〉20.0 × 10^9/L was day 13 （11 ～21 ）. All the patients got engraftment successfully and attained CR. Acute Ⅰ～Ⅱ GVHD occurred in 5 patients, no acute Ⅲ ～Ⅳ GVHD occurred and extensive chronic GVHD did in 2 patients. All the patients were alive and only one patient relapsed after 3 ～ 53 months follow-up. Conclusion TBI-based conditioning regimen appears to be safe and effective for non-T-depleted HLA mismatched hemotopoietic stem cell transplants, especially for high-risk and second transplant patients.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2007年第20期1613-1615,共3页
Chinese Journal of Practical Internal Medicine
关键词
造血干细胞移植
白血病
HLA不相合
全身照射
Hematopoietic stem cell transplants
Leukemia
HLA mismatch
Total body irradiation
