论文部分内容阅读
背景:造血干细胞移植使恶性血液病的预后得到很大的改观,外周血造血干细胞移植逐渐取代了骨髓移植而成为造血干细胞移植的主要方式。目的:观察自体或异基因外周血造血干细胞移植对53例恶性血液病患者的治疗效果。设计:随机对照观察。单位:郑州大学第一附属医院血液科骨髓移植中心。对象:选择2003-07/2006-05在郑州大学第一附属医院血液科收治的53例恶性血液病患者,男33例,女20例,平均37岁。35例患者行异基因外周血造血干细胞移植,其中急性髓细胞性白血病13例、急性淋巴细胞白血病7例、慢性粒细胞白血病10例、多发性骨髓瘤2例、骨髓增生异常综合征3例。18例患者行自体外周血造血干细胞移植,其中急性髓细胞性白血病7例、急性淋巴细胞白血病6例、多发性骨髓瘤2例、非霍奇金病3例。33名供者与受者HLA配型完全相合,2名1个位点不合,男20例,女13例,平均35岁。性别不相合者16例。实验经过医院伦理委员会批准许可,所有受试对象均对检测项目知情同意。方法:①利用粒系集落刺激因子或化疗联合粒系集落刺激因子动员外周血干细胞,自体移植患者接受CD34+细胞中位数为3.0×106/kg,异基因移植患者接受CD34+细胞中位数为6.2×106/kg;自体移植采用MAC预处理方案,异基因移植采用改良的Bu/Cy预处理方案;移植物抗宿主病的预防采用甲氨喋呤、环孢菌素A联合骁悉,1例1位点不合患者加用抗淋巴细胞球蛋白。②观察患者移植后中性粒细胞>0.5×109L-1和血小板>20×109L-1恢复时间。③观察患者移植物抗宿主病发生情况。④术后1年随访所有患者复发情况。主要观察指标:①中性粒细胞和血小板恢复时间。②移植后移植物抗宿主病发生情况。③随访结果。结果:纳入患者53例均进入结果分析。①自体移植患者移植后中性粒细胞>0.5×109L-1、血小板>20×109L-1的恢复时间分别为13和19d,在异基因移植患者中分别为12和15d。②异基因移植患者中Ⅰ~Ⅲ度急性移植物抗宿主病的发生率为31.4%,慢性移植物抗宿主病的发生率为71.4%。③术后患者自体移植和异基因移植患者复发率分别为38.9%和5.7%。结论:自体或异基因外周血造血干细胞移植较快建立恶性血液病患者造血能力,是治疗恶性血液病的重要手段。
BACKGROUND: Hematopoietic stem cell transplantation has greatly improved the prognosis of hematologic malignancies. Peripheral blood stem cell transplantation has gradually replaced bone marrow transplantation and become the main method of hematopoietic stem cell transplantation. Objective: To observe the therapeutic effect of autologous or allogeneic peripheral blood stem cell transplantation on 53 cases of hematological malignancies. Design: Randomized controlled observation. Unit: Department of Hematology and Bone Marrow Transplantation, First Affiliated Hospital of Zhengzhou University. PARTICIPANTS: Fifty-three patients with hematologic malignancies admitted to Department of Hematology, the First Affiliated Hospital of Zhengzhou University from July 2003 to May 2006 were selected, 33 males and 20 females, with an average of 37 years. Thirty-five patients underwent allogeneic peripheral blood stem cell transplantation, including 13 acute myeloid leukemia, 7 acute lymphoblastic leukemia, 10 chronic myeloid leukemia, 2 multiple myeloma and 3 myelodysplastic syndrome. Eighteen patients underwent autologous peripheral blood stem cell transplantation, including 7 acute myeloid leukemia, 6 acute lymphoblastic leukemia, 2 multiple myeloma and 3 non-Hodgkin’s disease. Totally, 33 donors and recipients were completely matched with HLA matching, and 1 out of 2 sites were heterogeneous. There were 20 males and 13 females, with an average of 35 years old. Gender disagreement in 16 cases. After the experiment was approved by the hospital ethics committee, all subjects were informed of the test items. Methods: ① Peripheral blood stem cells were mobilized by using granulocyte colony-stimulating factor or chemotherapy combined with granulocyte colony-stimulating factor. The median of CD34 + cells receiving autologous transplantation was 3.0 × 106 / kg. The median of CD34 + cells receiving allogeneic transplantation was 6.2 × 106 / kg; autologous transplantation with MAC pretreatment program, allogeneic transplantation with improved Bu / Cy preconditioning; graft-versus-host disease prevention with methotrexate, cyclosporin A combined with Xiao-Zai, 1 case 1 patients with additional anti-lymphocyte globulin. ② The recovery time of neutrophils> 0.5 × 109L-1 and platelets> 20 × 109L-1 after transplantation was observed. ③ observed patients with graft-versus-host disease occurred. ④ 1 year follow-up of all patients relapse. MAIN OUTCOME MEASURES: ① neutrophil and platelet recovery time. ② graft-versus-host disease after transplantation. ③ follow-up results. Results: 53 cases were included in the analysis of the results. ① The recovery time of neutrophils> 0.5 × 109L-1 and platelets> 20 × 109L-1 after autotransplantation were 13 and 19 days, respectively, and 12 and 15 days after allogeneic transplantation. ② The incidence of acute graft versus host disease in allogeneic transplantation was 31.4%, and the incidence of chronic graft versus host disease was 71.4%. ③ postoperative patients with autologous and allogeneic transplant recurrence rates were 38.9% and 5.7%. CONCLUSION: Autologous or allogeneic peripheral blood stem cell transplantation can rapidly establish hematopoietic capacity in patients with hematologic malignancies and is an important treatment for hematologic malignancies.