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目的探讨非骨髓清除性方案异基因外周血干细胞移植 (NSCT)治疗恶性血液病的临床效果。方法对 3例恶性血液病患者进行NSCT ,例 1为霍奇金淋巴瘤 (HL)自体外周血干细胞移植 (APBSCT)后 2年复发、肿瘤广泛浸润 ;例 2为骨髓增生异常骨髓纤维化综合征 (MDS MFS) ;另一例为慢性粒细胞白血病 (CML) ,预处理方案均采用低剂量放化疗方案。回输CD+ 34 细胞分别为 6.3 6× 10 6 个 /kg、2 9.4× 10 6 个 /kg、2 .8× 10 6 个 /kg。结果移植后分别于 +18、+2 8、+11天造血重建。例 1移植后 +2 4天出现aGVHDII度。 +3 0天复查骨髓细胞染色体核型 :10 0 %供者核型。 +60天达完全缓解 ,但于 +12 0天出现再次复发并死亡。例 2自体造血恢复 ,并达临床治愈。例 3于移植后 +2 8天出现混合嵌合体 ,并于 +4 5天转变为完全供者染色体 ,至 +2 40天仅出现轻度cGVHD发生。 3例患者均无移植相关并发症出现。结论NSCT移植相关毒性小 ,可适用于移植前一般状况较差及骨髓增生不良的患者 ;可诱导双向免疫耐受 ,从而使移植的HLA限制性有所放宽
Objective To investigate the clinical effect of non-myeloablative chemotherapy for allogeneic peripheral blood stem cell transplantation (NSCT) in the treatment of hematologic malignancies. Methods NSCT was performed in 3 patients with hematologic malignancies. Case 1 was recurrence 2 years after Hodgkin lymphoma (HL) autologous peripheral blood stem cell transplantation (APBSCT), with extensive tumor invasion. Case 2 was myelodysplastic myelofibrosis syndrome (MDS MFS); the other case is chronic myeloid leukemia (CML), pretreatment programs are used low-dose radiotherapy and chemotherapy program. The number of transfused CD + 34 cells was 6.3 6 × 10 6 cells / kg, 2 9.4 × 10 6 cells / kg and 2.8 × 10 6 cells / kg, respectively. Results The hematopoietic reconstructions were performed on + 18, + 28, + 11 days after transplantation. Example 1 aGVHDII degree occurred 24 days after transplantation. +3 0 days review bone marrow cell chromosome karyotype: 100% donor karyotype. Complete remission at +60 days, but relapse and death at +12 0 days. Example 2 autologous hematopoietic recovery, and up to clinical cure. Example 3 A mixed chimera appeared on day 28 after transplantation and became fully donor chromosomes on day +4 and only mild cGVHD occurred on day +40. None of the 3 patients had any transplant-related complications. Conclusions NSCT transplantation has low toxicity and can be applied to patients with poor general status and poor myeloproliferation before transplantation. It can induce bidirectional immune tolerance and relax the HLA restriction of transplantation