论文部分内容阅读
目的在高龄或同时存在不能耐受常规预处理方案的恶性血液病患者中,采用一种低强度预处理方案进行异基因造血干细胞移植治疗。方法12例患者中,急性淋巴细胞白血病(ALL)4例,慢性粒细胞白血病(CML)4例,伴原始细胞增多的难治性贫血(MDSRAEB)2例,急性髓系白血病2例。10例为HLA完全相合同胞移植,2例为1个位点不相合的同胞移植。预处理方案包括低剂量白消安2mg·kg-1·d-1,共3d,阿糖胞苷2g/m2,1～2次,环磷酰胺1.0g·m-2·d-1,共2d,抗胸腺细胞球蛋白(ATG)2.5mg·kg-1·d-1,共4d。11例患者采用经GCSF动员的供者骨髓加外周血干细胞移植,1例采用单纯外周血干细胞移植。输注有核细胞数平均为7.19×108/kg,CD34+细胞数平均为2.53×106/kg。急性移植物抗宿主病(aGVHD)预防采用环孢菌素A(CsA),短程甲氨蝶呤及霉酚酸酯联合方案。采用细胞遗传学、分子生物学及DNA短串联重复序列多态性(STR)分析方法鉴定供者干细胞植入情况。结果12例患者均能耐受此预处理方案,未发生严重预处理相关并发症。中性粒细胞绝对数>0.5×109/L的中位时间15(11～17)d,血小板植活中位时间15(10～23)d。移植后1个月鉴定植活情况,11例患者均全部转为供者型,1例患者为供、受者嵌合状态。出现aGVHD5例(41.6%),其中Ⅰ度2例,Ⅱ度2例,Ⅲ度1例,aGVHD发生率
Objective To treat allogeneic hematopoietic stem cell transplantation with a low-intensity preconditioning in elderly patients or in patients with hematologic malignancies who can not tolerate routine pretreatment regimens. Methods Four of 12 patients with acute lymphoblastic leukemia (ALL), 4 with chronic myeloid leukemia (CML), 2 with refractory anemia (MDSRAEB) with primary blasts, and 2 with acute myeloid leukemia. 10 cases of HLA-identical sibling transplants, 2 cases of a site incompatible siblings transplantation. The pretreatment regimen consisted of low dose busulfan 2 mg · kg -1 · d -1, total 3d, cytarabine 2 g / m 2, once or twice, cyclophosphamide 1.0 g · m -2 · d -1 2d, anti-thymocyte globulin (ATG) 2.5mg · kg-1 · d-1 for 4 days. Eleven patients were treated with GCSF mobilized donor bone marrow plus peripheral blood stem cell transplantation, 1 case of peripheral blood stem cell transplantation. The average number of infused nucleated cells was 7.19 × 108 / kg, and the average number of CD34 + cells was 2.53 × 106 / kg. Acute graft versus host disease (aGVHD) prophylaxis with cyclosporin A (CsA), short-course methotrexate and mycophenolate regimen. Cytogenetics, molecular biology and DNA short tandem repeat polymorphism (STR) analysis were used to identify donor stem cell engraftment. Results All the 12 patients were able to tolerate this pretreatment regimen without serious complications related to pretreatment. The median time of neutrophil> 0.5 × 109 / L was 15 (11 ~ 17) days, and the median time to platelet activation was 15 (10 ~ 23) days. One month after transplantation, the situation of engraftment was identified. All 11 patients were converted to donor type, and 1 patient was donor and recipient chimerism. There were 5 cases of aGVHD (41.6%), of which 2 cases were grade Ⅰ, 2 cases were grade Ⅱ, 1 case was grade Ⅲ. The incidence of aGVHD