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目的 :探讨异基因造血干细胞移植治疗白血病的疗效及主要并发症的处理。方法 :30例 5～ 5 0岁白血病患者 ,其中 2 5例接受HLA完全相合、2例接受 1～ 2个HLA主要位点不合同胞供者的外周血干细胞移植。2例接受HLA全相合的非血缘供者骨髓移植。 1例接受 1个HLA主要位点不合的非血缘脐带血移植。采用改良的环磷酰胺联合全身放疗 (CYTBI)或白消安环磷酰胺 (BUCY2 )方案预处理。采用环孢素A(CsA)联合短程甲氨蝶呤 (MTX)方案预防移植物抗宿主病 (GVHD) ,3例非血缘供者及HLA不全相合移植加用抗人胸腺细胞蛋白(ATG)、霉酚酸酯 (MMF)及抗CD2 5人鼠嵌合抗体。结果 :30例均获得植入 ,2例无关供者移植出现继发性植入失败。 13% (4/ 30 )出现Ⅰ～Ⅳ度急性GVHD ,2 6 .6 % (8/ 30 )出现慢性GVHD。并发间质性肺炎 2例。重症 (Ⅳ度 )出血性膀胱炎 1例。纯红细胞性再生障碍性贫血 1例。随访 2～ 34个月 ,现存活 2 1例 ,8例死于白血病复发 ,1例死于CMV相关的间质性肺炎。结论 :异基因造血干细胞移植是治疗白血病的有效方法 ,但移植前处于高危难治状态的病例复发率仍较高。
Objective: To investigate the efficacy and major complications of allogeneic hematopoietic stem cell transplantation in the treatment of leukemia. Methods: Twenty-five patients with leukemia from 5 to 50 years old, of whom 25 were HLA-identical and 2 received peripheral blood stem cell transplantation from 1 to 2 non-contracted donor sites. Two cases of HLA-matched non-donor bone marrow transplantation. One patient underwent non-blood cord blood transplants with one HLA-mismatched major site. A modified cyclophosphamide combined with systemic radiotherapy (CYTBI) or BCGT (BUCY2) regimen pretreatment. Cytosporine A (CsA) combined with short-course methotrexate (MTX) was used to prevent graft-versus-host disease (GVHD), 3 non-donor and HLA mismatched allograft with anti-human thymocyte protein (ATG) Mycophenolate mofetil (MMF) and anti-CD25 mouse chimeric antibody. Results: All 30 cases were implanted, and 2 cases of unrelated donors had failed secondary implantation. 13% (4/30) showed acute GVHD Ⅰ ~ Ⅳ, and 26.6% (8/30) showed chronic GVHD. Concomitant interstitial pneumonia in 2 cases. Severe (Ⅳ degree) hemorrhagic cystitis in 1 case. A case of pure red cell aplastic anemia. During the follow-up of 2 to 34 months, 21 survived, 8 died of leukemia and 1 died of CMV-related interstitial pneumonia. Conclusion: Allogeneic hematopoietic stem cell transplantation is an effective method for the treatment of leukemia. However, the recurrence rate of patients with high-risk and refractory status before transplantation is still high.