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目的比较HLA相合同胞异基因骨髓移植(allo-BMT)与异基因外周血造血干细胞移植(allo-PB-SCT)治疗慢性髓系白血病(CML)的临床疗效。方法allo-BMT 24例,allo-PBSCT 29例。预处理采用全身照射加环磷酰胺(TBI/Cy)或白消安加环磷酰胺(Bu/Cy)为主的方案。结果BMT组造血重建23例(95.8%),PBSCT组29例;PBSCT组外周血象恢复至中性粒细胞(ANC)>0.5×109/L、WBC>1×109/L、PLT>20×109/L的速度快于BMT组(P均<0.01)。BMT组急性移植物抗宿主病(aGVHD)15例(62.5%),PBSCT组21例(72.4%),2组比较差异无显著性(P>0.05);BMT组慢性GVHD(cGVHD)4例(18.2%),PBSCT组14例(53.8%),PBSCT组高于BMT组(P<0.05);BMT组移植相关死亡(TRM)3例(12.5%),复发4例(16.7%),5年无病生存率(DFS)(76.6±11.8)%,而PBSCT组TRM 7例(24.1%),复发1例(3.4%),5年DFS(75.5±8.1)%,2组比较差异均无显著性(P均>0.05)。结论allo-BMT和allo-PBSCT治疗CML疗效相当,allo-PBSCT组造血重建迅速,但cGVHD发生率高。
Objective To compare the clinical efficacy of HLA-identical sibling allogeneic bone marrow transplantation (allo-BMT) and allogeneic peripheral blood stem cell transplantation (allo-PB-SCT) in the treatment of chronic myelogenous leukemia (CML). Methods Allo-BMT 24 cases, allo-PBSCT 29 cases. Pretreatment with systemic irradiation with cyclophosphamide (TBI / Cy) or busulfan plus cyclophosphamide (Bu / Cy) -based program. Results The hematopoietic reconstitution was found in 23 (95.8%) patients in the BMT group and 29 in the PBSCT group. The peripheral blood count was 0.5 × 109 / L for neutrophil (ANC), WBC> 1 × 109 / L for PBSCT group, / L faster than BMT group (P <0.01). Fifteen patients (62.5%) with acute graft-versus-host disease (aGVHD) in BMT group and 21 patients (72.4%) in PBSCT group had no significant difference (P> 0.05); 4 patients with chronic GVHD (cGVHD) 18 cases in the PBSCT group were higher than those in the BMT group (P <0.05); 3 cases (12.5%) in the BMT group had recurrence-related death (TRM) (76.6 ± 11.8)%, while there was no significant difference between the two groups (7 cases with PBSCT, 24.1% with TRM, 1 with recurrence (3.4%) and 5 years with DFS (75.5 ± 8.1) (P> 0.05). Conclusion Allo-BMT and allo-PBSCT are effective in treating CML. The hematopoietic reconstitution is rapid in allo-PBSCT group, but the incidence of cGVHD is high.