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目的探讨非血缘供者异基因外周血造血干细胞移植治疗白血病的疗效、造血重建、并发症及长期生存情况。方法采用非血缘人类白细胞抗原(HLA)配型相合的外周血造血干细胞对37例急慢性白血病患者进行移植。预处理方案为白消安(马利兰)、环磷酰胺联合阿糖胞苷(BU/CY/Ara-c)或环磷酰胺联合全身放疗及阿糖胞苷(CY/TBI/Ara-c)。急性移植物抗宿主病(aGVHD)预防措施:采用环孢素A(CsA)、甲氨蝶呤(MTX)、抗胸腺细胞球蛋白(ATG)、霉酚酸酯(MMF)方案。输注非血缘供者异基因外周血造血干细胞的有核细胞中位数为9.42(4.33～16.00)×108/kg(受者体质量),CD3+4细胞中位数为6.76(1.06～20.00)×106/kg(受者体质量)。结果35例获造血重建,经血型、性染色体、DNA多态性监测证实植活,2例植入失败。中性粒细胞计数>0.5×109/L的时间为10～26 d,中位时间为15.8 d;血小板计数>20×109/L的时间为10～77 d,中位时间为19.6 d。Ⅰ～Ⅱ度aGVHD发生率为32%(12/37),Ⅲ度aGVHD发生率为5%(2/37),无Ⅳ度aGVHD发生;cGVHD发生率为24%(9/37)。随访1.5～90.0个月,30例存活,7例死亡,其中2例因植入失败死亡。结论非血缘供者异基因外周血造血干细胞移植是治疗急慢性白血病安全有效的方法,可使大部分白血病患者长期无病存活。
Objective To investigate the efficacy, hematopoietic reconstitution, complications and long-term survival of non-blood donor allogeneic peripheral blood stem cell transplantation in the treatment of leukemia. Methods Thirty-seven patients with acute and chronic leukemia were transplanted with peripheral blood hematopoietic stem cells matched with HLA non-HLA. Pretreatment regimen consisted of busulfan, cyclophosphamide plus cytarabine (BU / CY / Ara-c) or cyclophosphamide combined with systemic radiotherapy and cytarabine (CY / TBI / Ara-c). Acute graft versus host disease (aGVHD) Precautions: Cyclosporine A (CsA), methotrexate (MTX), anti-thymocyte globulin (ATG) and mycophenolate mofetil (MMF) regimens were used. The median number of nucleated cells in non-blood donor allogeneic peripheral blood hematopoietic stem cells was 9.42 (4.33-16.00) × 108 / kg (recipient body mass), and the median of CD3 + 4 cells was 6.76 (1.06-20.00 ) × 106 / kg (recipient mass). Results 35 cases were reconstructed by hematopoiesis, confirmed by blood type, sex chromosome and DNA polymorphism, and 2 cases failed implantation. Neutrophil count> 0.5 × 109 / L for 10 ~ 26 d, median time was 15.8 d; platelet count> 20 × 109 / L for the time of 10 ~ 77 d, the median time was 19.6 d. The incidence of grade Ⅰ ~ Ⅱ aGVHD was 32% (12/37). The incidence of grade Ⅲ aGVHD was 5% (2/37), with no grade Ⅳ aGVHD. The incidence of cGVHD was 24% (9/37). After 1.5 to 90.0 months of follow-up, 30 patients survived and 7 died. Two of them died of implantation failure. Conclusion Non-blood donor allogeneic peripheral blood stem cell transplantation is a safe and effective method for the treatment of acute and chronic leukemia, which can lead to long-term disease-free survival of most leukemia patients.