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目的:对没有与供者HLA配型相合的血液恶性肿瘤患者来说,自体造血干细胞移植不失为一种积极有效的治疗方法。评价比较单次与两次自体造血干细胞移植治疗血液肿瘤的效果。方法:①实验对象:选取1988～2001年解放军总医院血液科行自体造血干细胞移植的150例患者,对本实验均知情同意。其中两次自体移植25例(两次骨髓移植3例、两次外周血造血干细胞移植1例、1次骨髓移植+1次外周血造血干细胞移植21例),单次自体移植125例(骨髓移植44例、外周血造血干细胞移植81例);急性非淋巴细胞白血病75例,急性淋巴细胞白血病43例,非霍奇金淋巴瘤22例,霍奇金淋巴瘤10例。②实验方法:应用化疗使白血病患者在移植前达到完全缓解,淋巴瘤患者要求移植前至少骨髓中没有肿瘤累及。动员化疗方案原则上采用对相应肿瘤有效的联合化疗方案,并适当增加剂量。骨髓移植及外周血造血干细胞移植患者回输单核细胞中位数分别为2.68×108/kg,4.20×108/kg。115例患者采用环磷酰胺/全身放疗方案,35例患者采用不含全身放疗的高剂量化疗方案。③实验评估:自体造血干细胞移植5年后血液肿瘤患者的无病存活率。结果:①急性非淋巴细胞白血病:69例患者单次移植,5年无病存活率58.0%(40例),复发率29.0%(20例),移植相关死亡率13.0%(9例)。6例患者两次移植,其中1例M5患者复发死亡,5例无病存活。②急性淋巴细胞白血病:29例患者单次移植,5年无病存活率34.5%(10例),复发率34.5%(10例),移植相关死亡率31.0%(9例)。14例患者两次移植,5年无病存活率42.9%。③非霍奇金淋巴瘤:18例患者单次移植,5年无病存活率61.1%(11例),复发率16.7%(3例),移植相关死亡率22.2%(4例)。4例患者两次移植,其中1例CR1期患者在首次移植后21个月复发,化疗获得PR后行第2次自体造血干细胞移植,17个月后复发死亡;其余3例均无病存活。④霍奇金淋巴瘤:9例患者单次移植,5年无病存活率100%。1例患者行两次移植,首次移植前13个化疗疗程未缓解,行自体外周血造血干细胞移植后达到部分缓解,9个月后行自体骨髓移植后完全缓解,无病存活。结论:①自体造血干细胞移植是治疗血液肿瘤安全有效的方法。②自体造血干细胞两次移植5年无病存活率明显优于单次移植效果,可改善血液肿瘤患者预后。
OBJECTIVE: Autologous hematopoietic stem cell transplantation is an active and effective treatment for patients with hematological malignancies that do not have an HLA match with their donor. Evaluation of single and double autologous hematopoietic stem cell transplantation for the treatment of hematologic malignancies. Methods: ① Subjects: 150 patients with autologous hematopoietic stem cell transplantation from Department of Hematology, Chinese PLA General Hospital from 1988 to 2001 were selected and informed consent was obtained. Two of them were autograft in 25 cases (two bone marrow transplantation in three cases, two in peripheral blood stem cell transplantation in one case, one in bone marrow transplantation + one in peripheral blood hematopoietic stem cell transplantation in 21 cases), a single autotransplantation in 125 cases (bone marrow transplantation 44 cases, 81 cases of peripheral blood stem cell transplantation); 75 cases of acute non-lymphocytic leukemia, 43 cases of acute lymphoblastic leukemia, 22 cases of non-Hodgkin’s lymphoma and 10 cases of Hodgkin’s lymphoma. ② experimental methods: the application of chemotherapy to achieve complete remission of leukemia patients before transplantation, lymphoma patients require at least bone marrow involvement before tumor involvement. In principle, the mobilization chemotherapy regimen adopts the combination chemotherapy which is effective on the corresponding tumor, and increases the dose appropriately. The median number of mononuclear cells transfused by bone marrow transplantation and peripheral blood stem cell transplantation were 2.68 × 108 / kg and 4.20 × 108 / kg, respectively. One hundred and fifty-five patients received cyclophosphamide / systemic radiotherapy and 35 patients received high-dose chemotherapy without systemic radiation. ③ experimental evaluation: Autologous hematopoietic stem cell transplantation in patients with disease-free survival after 5 years. Results: ① Acute non-lymphocytic leukemia: 69 patients were single-grafted. The 5-year disease-free survival rate was 58.0% (40 cases), the recurrence rate was 29.0% (20 cases) and the graft-related mortality rate was 13.0% (9 cases). Six patients were transplanted twice, of which one M5 patient died of recurrence and five patients survived without disease. ② Acute lymphoblastic leukemia: 29 patients were single transplanted. The 5-year disease-free survival rate was 34.5% (10 cases), the recurrence rate was 34.5% (10 cases) and the graft-related mortality rate was 31.0% (9 cases). Fourteen patients were transplanted twice, with a 5-year disease-free survival rate of 42.9%. ③ Non-Hodgkin’s lymphoma: 18 cases of single transplant, 5-year disease-free survival rate of 61.1% (11 cases), the recurrence rate was 16.7% (3 cases), graft-related mortality was 22.2% (4 cases). Four patients were transplanted twice. One CR1 patient relapsed 21 months after the first transplant. The second autologous hematopoietic stem cell transplantation was performed after PR was obtained after chemotherapy. The other three patients died of recurrence after 17 months. The other 3 patients survived without disease. ④ Hodgkin’s lymphoma: 9 patients with a single transplant, 5-year disease-free survival rate of 100%. One patient underwent two transplantations. Before the first transplant, the 13 chemotherapy regimens were not relieved. The autologous peripheral blood hematopoietic stem cells were partially relieved after autologous peripheral blood stem cell transplantation. After 9 months, the patients were completely relieved of autologous bone marrow transplantation and survived without disease. Conclusion: ① Autologous hematopoietic stem cell transplantation is a safe and effective method for the treatment of hematologic malignancies. ② The five-year disease-free survival rate of autologous hematopoietic stem cell transplantation was significantly better than that of single transplantation, which could improve the prognosis of patients with hematological malignancies.