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背景与目的:预处理方案是造血干细胞移植成功的关键因素之一。本研究的目的是比较异基因造血干细胞移植两种预处理方案治疗白血病的优缺点。方法:21例采用白消安(busulfan,BU)16mg/kg加环磷酰胺(cyclophosphamide,CY)120mg/kg方案(BU/CY组);23例采用全身照射(totalbodyirradiation,TBI)7.5～8.5Gy加CY120mg/kg方案(TBI/CY组)。结果:BU/CY组和TBI/CY组3年无病生存率分别为61.5%与64.7%,复发率分别为23.8%与26.0%,两者差异无显著性(P>0.05)。BU/CY组肝脏毒性发生率高于TBI/CY组,分别为80.9%与54.3%(P<0.05),均无发生肝静脉闭塞病。BU/CY组口腔和胃肠道毒性发生率(33.3%与42.9%)则明显低于TBI/CY组(78.2%与78.2%)(P<0.05);膀胱和肺毒性的发生率两组相似,前者为23.8%与26.0%,后者为14.3%与13.0%(P>0.05),但TBI/CY组发生1例致死性的Ⅳ级肺毒性。两组均未发生心脏、肾和中枢神经系统不良反应。结论:BU/CY组疗效与TBI/CY组相当。BU/CY组预处理方案易于实施,患者耐受好,髓外毒性低。
Background and Objective: Pretreatment protocol is one of the key factors in the success of hematopoietic stem cell transplantation. The purpose of this study was to compare the advantages and disadvantages of two pretreatment regimens of allogeneic hematopoietic stem cell transplantation in the treatment of leukemia. Methods: Twenty-one patients were given bupivacaine (BU / CY) with 16 mg / kg cyclophosphamide (CY) at 120 mg / kg and busulfan (BU) Plus CY120mg / kg regimen (TBI / CY group). Results The 3-year disease-free survival rates of BU / CY group and TBI / CY group were 61.5% and 64.7%, respectively, and the recurrence rates were 23.8% and 26.0% respectively. There was no significant difference between the two groups (P> 0.05). The incidence of hepatic toxicity in BU / CY group was higher than that in TBI / CY group (80.9% and 54.3%, respectively) (P <0.05). No hepatic vein occlusion occurred. The incidence of oral and gastrointestinal toxicity (33.3% and 42.9%) in BU / CY group was significantly lower than that in TBI / CY group (78.2% and 78.2%, P <0.05) , The former was 23.8% and 26.0%, the latter was 14.3% and 13.0% (P> 0.05), but one case of fatal grade Ⅳ pulmonary toxicity occurred in TBI / CY group. No heart, kidney and central nervous system adverse reactions occurred in either group. Conclusion: The efficacy of BU / CY group is similar to that of TBI / CY group. BU / CY group pretreatment program easy to implement, patients with good tolerance, low extramedullary toxicity.