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探讨非血缘供者异基因骨髓移植对慢性粒细胞白血病的治疗 ,并对移植相关并发症作了详细观察和处理。预处理方案为标准 Bu Cy,马利兰 (Bu) 4 mg/(kg· d)× 4;环磷酰胺 (Cy) 6 0 mg/(kg· d)× 2。2例供者均来自台湾慈济骨髓捐赠中心 ,HL A基因配型 (SSOP法 )与患者完全配合。采髓量分别为 12 30 m l和 10 10 ml,其中植入的单个核细胞为 2 .13× 10 8/kg和 2 .38× 10 8/kg;CD34+细胞为 2 .3× 10 6 /kg和 2 .8× 10 6 /kg;CFU- GM4.6× 10 5个 /kg和 5 .3× 10 5个 /kg,BFU- E1.2× 10 5个 /kg和 1.7× 10 5个 /kg,CFU- GEMM3.6× 10 5个 /kg和 4.5× 10 5个 /kg。移植物抗宿主病的预防采用环胞素 A+氨甲蝶呤 +人体丙种球蛋白。结果 :在移植后 + 2 4和 + 16天患者中性粒细胞恢复达≥ 0 .5× 10 9/L,在 + 6 4和 + 45天血小板≥ 2 .0× 10 9/L,+ 30天骨髓染色体核型分析 ,2例均达 90 %以上供者嵌合 ,+ 10 0天达完全嵌合 ,Ph1染色体 (- ) ,血型转变为供者血型 ,DNA可变数目重复序列检测 (VNTR)证实供者源造血重建。结论 :HL A相合非血缘异基因骨髓移植治疗慢性粒细胞白血病获得成功 ,重建了患者造血功能 ;移植相关并发症的及时发现和正确处理是保证移植成功的重要因素。
To investigate the treatment of chronic myelogenous leukemia by allogeneic bone marrow transplantation in non-blood donors, and to observe and deal with the complications related to transplantation. The pretreatment protocol was Bu Bu, 4 mg / (kg · d) × 4 and 60 mg / (kg · d) × 2.2 Cyclophosphamide (Cy) were from Tzu Chi Bone marrow donation center, HL A gene assignment (SSOP method) and the patient fully cooperate. The amount of harvested pulp was 12 30 ml and 10 10 ml respectively, with 2.13 × 10 8 / kg and 2.38 × 10 8 / kg of implanted mononuclear cells and 2.3 × 10 6 / kg of CD34 + cells And 2.2 × 10 6 / kg; CFU-GM 4.6 × 10 5 / kg and 5.3 × 10 5 / kg, BFU-E1 0.2 × 10 5 / kg and 1.7 × 10 5 / kg, CFU-GEMM 3.6 × 10 5 / kg and 4.5 × 10 5 / kg. Prevention of graft versus host disease using cyclosporine A + methotrexate + human gamma globulin. Results: The neutrophil recovery was ≥0.5 × 10 9 / L at +24 and +16 days after transplantation, with platelets ≥ 2.0 × 10 9 / L and +30 at +64 and +45 days The bone marrow chromosome karyotype analysis showed that more than 90% donor chimerism was achieved in 2 cases, full chimerism on day 10, Ph1 chromosome (-), blood type was changed to donor blood type, DNA variable number repeat detection Confirmed donor source hematopoiesis reconstruction. CONCLUSION: HL A coincident non-hereditary allogeneic bone marrow transplantation has been successfully used in the treatment of chronic myelogenous leukemia and reconstructed the hematopoietic function of patients. The timely detection and correct treatment of complications related to transplantation is an important factor to ensure the successful transplantation.