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目的探讨非清髓性造血干细胞移植后白血病复发的防治。方法7例合并有其它系统疾病的白血病患者接受非清髓性外周血干细胞移植,移植后采用环孢素A及短程甲氨蝶呤预防移植物抗宿主病(GVHD),造血细胞植入后,动态检测骨髓单个核细胞嵌合体的变化,根据嵌合体状态,采用供者淋巴细胞输注(DLI),并配合环孢素A用量的调整来防治白血病复发。结果7例患者移植后造血功能得到恢复,3例移植前合并的疾病有所加重,经处理缓解,移植早期相关并发症少而轻。移植后有3例嵌合体由混合嵌合体(MC)转为完全供者型嵌合体(CC),再转为MC,伴Ph染色体阳性,DLI5~6次后Ph染色体转为阴性,嵌合体状态又转为CC,其中2例发生广泛皮肤慢性GVHD;3例的嵌合体持续为CC,无复发,其中2例接受了1次DLI,此2例在环孢素A减量过程中发生GVHD;1例的嵌合体持续为MC,虽经3次DLI,但无效,患者死于白血病复发。结论非清髓性造血干细胞移植后应动态监测嵌合体状态,采用供者淋巴细胞输注,并配合环孢素A用量的调整,对白血病的复发有一定的效果。
Objective To investigate the prevention and treatment of leukemia recurrence after non-myeloablative hematopoietic stem cell transplantation. Methods Seven patients with leukemia complicated with other systemic diseases underwent non-myeloablative peripheral blood stem cell transplantation. After transplantation, cyclosporine A and short-range methotrexate were used to prevent graft-versus-host disease (GVHD). After hematopoietic cell transplantation, Dynamic detection of bone marrow mononuclear cell chimerism changes, according to the state of chimerism, using donor lymphocyte infusion (DLI), and with the adjustment of cyclosporin A dosage to prevent leukemia recurrence. Results The hematopoietic function of 7 patients recovered after transplantation, and the disease of 3 patients before transplantation was aggravated. After treatment, the complications of early transplantation were few and light. After transplantation, 3 chimeras were transformed from mixed chimera (MC) to full donor chimera (CC), then to MC with positive Ph chromosome. Ph chromosome turned negative after 5-6 DLI, and chimera status 2 cases had extensive skin chronic GVHD. Three cases of chimerism continued to be CC with no recurrence. Two of them received DLI once. The two cases developed GVHD in the course of cyclosporin A reduction. One case of chimerism continued to be MC, although 3 times DLI, but invalid, the patient died of leukemia relapse. Conclusion Non-myeloablative hematopoietic stem cell transplantation should dynamically monitor the status of chimerism, the use of donor lymphocytes infusion, with the adjustment of the amount of cyclosporine A, the recurrence of leukemia have a certain effect.