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为研究非清髓性异基因造血干细胞移植(non-myeloablativeallogeneicstemcelltransplantation,allo-NST)治疗恶性血液病的疗效及相关技术,选择26例恶性血液病患者作为研究对象(急性白血病10例,慢性髓性白血病14例,多发性骨髓瘤2例),其中14例采用FAC(fludarabin+ATG+Cy)预处理,12例采用MAC(melfalan/maleran+ATG+Cy)预处理;用G-CSF600μg/d或G-CSF300μg/d+GM-CSF300μg/d进行外周血干细胞动员,于第5天开始用CobeSpectra血细胞分离机连续采集2-3次;用环孢菌素A联合短程甲氨蝶呤预防GVHD;移植后第4周开始供体淋巴细胞输注,首剂1×107/kg,之后依据临床反应及嵌合体形成情况,每4周1次,剂量逐级递增;微卫星短串联重复序列(STR)分析、Bcr/Abl融合基因、Ph染色体、HLA位点分析、性染色体及ABO血型等为植活检测指标。结果显示植入率84.62%,aGVHD发生率11.54%,cGVHD发生率23.07%;感染和出血等毒副反应发生率低、反应轻。结论非清髓性异基因造血干细胞移植治疗恶性血液病疗效确切,毒副作用小,但相关技术,如适应症的选择、预处理方案、移植过程中的免疫治疗等需要进一步深入研究。
Twenty-six patients with hematologic malignancies were selected as study subjects (acute leukemia in 10, chronic myeloid leukemia, non-myeloablative allogenic stem cell transplantation, allo-NST) for the treatment of hematologic malignancies. 14 cases, 2 cases of multiple myeloma), of which 14 cases were pretreated with FAC (fludarabin + ATG + Cy) and 12 cases were treated with MAC (melfalan / maleran + ATG + Cy) -CSF300μg / d + GM-CSF300μg / d for peripheral blood stem cell mobilization, beginning on the fifth day with Cobe Spectra blood cell separator continuous collection of 2-3 times; with cyclosporine A combined with short-range methotrexate to prevent GVHD; after transplantation Week 4 began donor lymphocyte infusion, the first dose of 1 × 107 / kg, then based on clinical response and chimerism, once every 4 weeks, the dose increased step by step; microsatellite short tandem repeat (STR) analysis , Bcr / Abl fusion gene, Ph chromosome, HLA loci analysis, sex chromosomes and ABO blood group were the indicators of plant survival. The results showed that the implantation rate was 84.62%, the incidence of aGVHD was 11.54% and the incidence of cGVHD was 23.07%. The incidence of toxic and side effects such as infection and hemorrhage was low and the reaction was mild. Conclusion Non-myeloablative allogeneic hematopoietic stem cell transplantation is effective in the treatment of hematologic malignancies. However, the related technologies such as choice of indications, pretreatment protocols and immunotherapy in transplantation need further study.