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目的 分析马利兰和环磷酰胺 (BU CY)作为异基因外周血干细胞移植 (allo PBSCT)预处理方案的治疗相关并发症。方法 分析 1997年 6月至 1999年 5月我院 40例allo PBSCT患者的临床资料。结果 中性粒细胞和血小板植活中位数时间分别为移植后 13(9～ 2 8)天和 12 (7～ 6 0 )天 ;40例中17例 (42 5 % )发生急性移植物抗宿主病 (aGVHD) ,其中Ⅱ～Ⅳ度aGVHD 10例 (2 5 % ) ;在可评价的 30例中 2 1例 (70 % )发生cGVHD ;发生轻至重度口腔粘膜炎 30例 ,其中 4例发生严重食管炎伴出血 ;发生出血性膀胱炎 8例 (2 0 % ) ,中位数时间为 +10 0 (+7～ +16 5 )天 ;发生间质性肺炎 6例 (2 0 % ) ,其中 5例巨细胞病毒感染 ,1例卡氏肺囊虫感染 ;无一例发生肝静脉闭塞病和癫痫样发作。随访中位数时间 480(30 0～ 10 0 0 )d ,复发 4例 (10 % ) ,死于移植相关并发症 8例 (2 0 % ) ,3年无白血病生存 2 8例 (70 % )。结论 以国产马利兰组成的BU CY预处理方案易于实施 ,患者耐受好 ,髓外毒性低。
Objective To analyze the treatment-related complications of both marlyan and cyclophosphamide (BU CY) as a pretreatment regime for allogeneic peripheral blood stem cell transplantation (allo PBSCT). Methods Clinical data of 40 patients with allo-PBSCT from June 1997 to May 1999 in our hospital were analyzed. Results The median time for engraftment of neutrophils and platelets was 13 (9 to 28) days and 12 (7 to 60 days) after transplantation, respectively; acute graft allograft resistance occurred in 17 (42.5%) of 40 patients. Host disease (aGVHD), including aGVHD II to IV degree in 10 cases (25%); cGVHD occurred in 21 cases (70%) of 30 evaluable cases; 30 cases of mild to severe oral mucositis, including 4 cases Severe esophagitis with hemorrhage; hemorrhagic cystitis occurred in 8 cases (20%), median time was +10 0 (+7 to +16 5) days; 6 cases of interstitial pneumonia occurred (20%) Among them, 5 cases were infected with cytomegalovirus and 1 case of Pneumocystis carinii infection; none had hepatic vein occlusion and epileptic seizures. The median follow-up time was 480 (300-1000)d, 4 cases (10%) recurred, 8 cases (20%) died of transplantation-related complications, and 28 cases (70%) survived without leukemia for 3 years. . Conclusion The BU CY pretreatment regimen consisting of domestically produced Marlyn is easy to implement, with good patient tolerance and low extramedullary toxicity.