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目的探讨非亲缘异基因造血干细胞移植(URD-HSCT)治疗白血病的效果。方法 10例白血病患者(急性髓细胞白血病第1次缓解期3例,急性淋巴细胞白血病第1次缓解期3例、第2次缓解期1例,慢性髓细胞白血病慢性期3例)接受URD-HSCT治疗。所有患者均采用经典的或改良的白消安联合环磷酰胺预处理方案。4例采用环孢素+短程甲氨蝶呤+吗替麦考酚酯预防移植物抗宿主病(GVHD),另6例患者加用抗胸腺细胞免疫球蛋白。输注供者有核细胞中位数为5.6×108/kg,CD34+细胞中位数为3.3×106/kg。结果除1例在移植后早期死亡不能评估外,其余9例均证实植活。发生急性GVHDⅠ度3例和Ⅱ度、Ⅲ度、Ⅳ度各1例,局限性慢性GVHD7例;发生真菌感染4例、CMV血症3例、出血性膀胱炎3例。10例患者目前无病存活7例,生存期为3个月～10年。结论 URD-HSCT安全而耐受性好,移植相关并发症仍是影响URD-HSCT效果的主要问题。
Objective To investigate the effect of non-related allogeneic hematopoietic stem cell transplantation (URD-HSCT) on leukemia. Methods Ten patients with leukemia (acute myeloid leukemia in the first remission in 3 cases, acute lymphoblastic leukemia in the first remission in 3 cases, the second remission in 1 cases, chronic myeloid leukemia chronic 3 cases) received URD- HSCT treatment. All patients were treated with a classic or modified busulfan combined with cyclophosphamide preconditioning. 4 cases of cyclosporine + short-term methotrexate + mycophenolate mofetil to prevent graft-versus-host disease (GVHD), the other 6 patients with anti-thymocyte immunoglobulin. The median of donor nucleated cells was 5.6 × 108 / kg and the median of CD34 + cells was 3.3 × 106 / kg. Results In addition to 1 case of early death after transplantation can not be assessed, the remaining 9 cases were confirmed alive. One case of acute GVHD occurred in one case with grade I and one case with grade II, III and IV, and localized chronic GVHD in seven cases. Four cases were found with fungal infection, three with CMV and three with hemorrhagic cystitis. 10 patients without disease-free survival in 7 cases, the survival period of 3 months to 10 years. Conclusions URD-HSCT is safe and well-tolerated. The complications related to transplantation are still the main problems affecting the efficacy of URD-HSCT.