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目的观察不同来源的异基因造血干细胞移植治疗白血病的疗效并探讨主要并发症的处理方案。方法对2001年9月至2007年3月第四军医大学西京医院血液科76例白血病患者行异基因造血干细胞移植治疗,其中慢性粒细胞白血病34例,急性髓性白血病24例,急性淋巴细胞白血病15例,T细胞淋巴瘤/白血病3例。人类白细胞抗原(HLA)全相合的同胞供者57例,1个HLA位点不合同胞供者3例,HLA单倍型半相合同胞供者7例,非血缘供者9例。预处理方案采用改良的马利兰联合环磷酰胺(BUCY)或改良的环磷酰胺联合全身放疗及阿糖胞苷或鬼臼乙叉甙(CyTBI+Ara-c/VP-16)方案。采用标准的环孢素A(CsA)联合短期甲氨蝶呤(MTX)方案预防移植物抗宿主病(GVHD);无关供者移植加用抗人胸腺细胞球蛋白,单倍型半相合移植同时加用CD25单克隆抗体。结果96.1%(73/76)获得植入。24.7%(18/73)出现急性GVHD,32.9%(24/73)出现慢性GVHD;合并重症肝静脉闭塞病2例;并发纯红细胞性再生障碍性贫血5例。随访3~72个月,现存活56.6%(43/76),43.4%(33/76)在移植后1~36个月时死亡,19例死于白血病复发,14例死于移植相关并发症。结论多种来源的异基因造血干细胞移植是治疗白血病的有效方法,于慢性粒细胞白血病慢性期、急性白血病缓解期移植效果较好,移植前处于高危难治状态的病例复发率仍较高。
Objective To observe the efficacy of different kinds of allogeneic hematopoietic stem cell transplantation in the treatment of leukemia and to explore the treatment of major complications. Methods From September 2001 to March 2007, 76 leukemia patients from Department of Hematology, Xijing Hospital of the Fourth Military Medical University underwent allogeneic hematopoietic stem cell transplantation. Among them, 34 cases were chronic myeloid leukemia, 24 cases were acute myeloid leukemia, acute lymphoblastic leukemia 15 cases, T-cell lymphoma / leukemia in 3 cases. Fifty-seven siblings donated by human leukocyte antigen (HLA), three cases with one donor HLA-1, seven HLA haploidentical haploidentical sibling donors, and nine non-donor donors. The pretreatment regimen consisted of a modified Bifidobacterium marxiflorum plus cyclophosphamide (BUCY) or modified cyclophosphamide combined with systemic radiotherapy and cytarabine or etoposide (CyTBI + Ara-c / VP-16) regimen. Standard cyclosporin A (CsA) combined with short-term methotrexate (MTX) regimen for the prevention of graft versus host disease (GVHD); unrelated donor transplantation plus anti-human thymocyte globulin haplotype haploidentical transplantation Add CD25 monoclonal antibody. Results 96.1% (73/76) were implanted. There were 24.7% (18/73) cases of acute GVHD and 32.9% (24/73) cases of chronic GVHD. There were 2 cases of severe hepatic veno-occlusive disease and 5 cases of pure red cell aplastic anemia. During the follow-up of 3 to 72 months, 56.6% (43/76) survived and 43.4% (33/76) died at 1-36 months after transplantation. Nineteen patients died of leukemia relapse and 14 patients died of transplant-related complications . Conclusions Allogeneic hematopoietic stem cell transplantation from multiple sources is an effective method for the treatment of leukemia. It has a good effect in chronic phase of chronic myeloid leukemia and acute leukemia in remission stage, and the recurrence rate is still high before transplantation in high-risk refractory state.