论文部分内容阅读
目的 比较自体与异体造血干细胞移植 (HSCT)治疗白血病和非霍杰金氏淋巴瘤 (NHL)的疗效和移植相关死亡。方法 2 2 2例白血病和NHL中 ,112例接受自体HSCT、110例接受异体HSCT ,其中38例急性早幼粒细胞白血病 (M3 )和 36例NHL均为自体HSCT。移植预处理方案包括 :14 9例TBI +Cy、2 3例改良Bucy、5 0例MACC方案。 结果 全部患者均获得造血重建 ,在自体与异体移植后白细胞>1.0× 10 9/L和血小板 >2 0× 10 9/L的时间 ,二组分别为 (14 .3± 6 .1)d和 (17.8± 9.2 )d与 (15 .1±4 .6 )d和 (19.6± 10 .3)d ,二组比较造血重建时间无差异 (P >0 .0 1)。非M3 白血病自体与异体移植后 5年估计无病生存率为 (5 2 .0± 5 .8) %和 (6 2 .4± 6 .2 ) %、复发率为 (44 .7%和 14 .5 % ) ,M3 白血病自体移植无病生存率 (93.6± 4 .4 ) %、复发率 5 .3% ,NHL自体移植无病生存率 (6 6 .3± 8.0 ) %、复发率 2 2 .2 %。自体与异体移植相关并发症致死率 5 .3%和 19.1% (P <0 .0 1)。结论 异体HSCT治疗的白血病 5年无病生存率优于自体HCST ,移植后白血病复发率低于自体移植 ,但移植后相关并发症死亡率高于自体移植 ,自体移植对于急性髓系白血病 (AML)、尤其是M3 和NHL具有较高的临床治愈率。
Objective To compare the efficacy and transplant-related deaths of autologous and allogeneic hematopoietic stem cell transplantation (HSCT) in the treatment of leukemia and non-Hodgkin’s lymphoma (NHL). Methods In 222 cases of leukemia and NHL, 112 cases received autologous HSCT and 110 cases received allogenic HSCT. 38 cases of acute promyelocytic leukemia (M3) and 36 cases of NHL were all autologous HSCT. Transplantation pretreatment programs include: 14 9 cases of TBI + Cy, 23 cases of modified Bucy, 50 cases of MACC program. Results All patients received hematopoietic reconstitution. The time of autologous and allogeneic transplantation with white blood cells> 1.0 × 10 9 / L and platelets> 20 × 10 9 / L were (14.3 ± 6.1) days and (17.8 ± 9.2) days and (15.1 ± 4.66 days), and (19.6 ± 10.3 days) respectively. There was no difference in hematopoietic reconstitution time between the two groups (P> 0.05). The estimated disease-free survival after 5 years of autologous and allotransplantation of non-M3 leukemia was (52.0 ± 5.8)% and (6.2 ± 6.2%), respectively, with a recurrence rate of 44.7% and 14 .5%), disease-free survival rate of M3 leukemia autograft (93.6 ± 4.4%), recurrence rate of 5.3%, disease free survival rate of NHL autograft (66.3 ± 8.0)% and recurrence rate of 22 .2 %. Mortality rates of complications associated with autologous and allograft were 5.3% and 19.1%, respectively (P <0.01). Conclusion The 5-year disease-free survival rate of leukemia treated with allogeneic HSCT is better than that of autologous HCT. The relapse rate of leukemia after transplantation is lower than that of autologous transplantation, but the mortality rate of related complications after transplantation is higher than that of autologous transplantation. Autologous transplantation for acute myeloid leukemia (AML) , Especially M3 and NHL have a higher clinical cure rate.