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目的 采用S999方案中异基因外周血干细胞移植 (allo PBSCT)治疗白血病 ,评价其疗效并观察移植物抗宿主病 (GVHD)等并发症。方法 1999年 9月～ 2 0 0 2年 9月间 ,共完成allo PBSCT治疗成人白血病 5 0例 ,其中慢性粒细胞白血病 (CML) 2 8例 ,急性髓细胞白血病 (AML) 13例 ,急性淋巴细胞白血病 (ALL) 9例。外周血干细胞动员方案 :格拉诺赛特 (G CSF) 5 μg·kg- 1 ·d- 1 × 5d ;移植预处理主要采用环磷酰胺 (CTX) +足叶乙甙 (VP16) +全身照射 (TBI)方案 :CTX 5 0～ 60mg·kg- 1 ·d- 1 × 2d ;VP162 0mg·kg- 1 ·d- 1 × 2d或 5 0mg·kg- 1 ·d- 1 × 1d ,TBI 6.5～ 8.0Gy单次照射或l2 .0Gy分 3次照射 ;GVHD预防采用常规环孢素A(CsA)+短程氨甲喋呤 (MTX)和霉酚酸脂 (MMF)联合CsA +MTX两种方案。结果 本组患者除 1例移植早期因并发真菌感染而导致败血症死亡外 ,余 49例均获得完全供体型造血功能重建。中性粒细胞恢复至 0 .5× 10 9/L及血小板恢复至 2 0× 10 9/L的中位时间分别为移植后 14d( 10～ 2 2d)及 19d( 10～ 68d)。 49例移植成功者发生急性GVHD 16例 ( 3 2 .7% ) ,其中Ⅲ～Ⅳ度 5例 ( 10 .2 % )。 3 6例生存 6个月以上者发生慢性GVHD 2 4例( 66.7% ) ,其中广泛性 5例 ( 13 .9% )。MMF +CsA +M
Objective To evaluate the efficacy of allogeneic peripheral blood stem cell transplantation (allo PBSCT) for the treatment of leukemia with S999 regimen and to observe the complications such as graft versus host disease (GVHD). Methods From September 1999 to September 2002, 50 cases of adult leukemia were treated with allo PBSCT, including 28 cases of chronic myeloid leukemia (CML), 13 cases of acute myeloid leukemia (AML), 15 cases of acute lymphocytic leukemia Cell leukemia (ALL) in 9 cases. Mobilization of peripheral blood stem cells: G CSF 5 μg · kg-1 · d-1 × 5d; transplantation pretreatment with CTX + VP16 + whole body irradiation TBI): CTX 50 ~ 60 mg · kg -1 · d -1 × 2d; VP1620 mg · kg -1 · d -1 × 2d or 50 mg · kg -1 · d -1 × 1d, TBI 6.5-8.0 Gy single irradiation or l2. 0Gy three times irradiation; prevention of GVHD with conventional cyclosporine A (CsA) + short-range methotrexate (MTX) and mycophenolic acid (MMF) combined with CsA + MTX two programs. Results In addition to the death of sepsis caused by complicated fungal infection in one patient in the early stage of transplantation, the remaining 49 patients received complete donor hematopoietic reconstitution. The median time of neutrophil recovery to 0.5 × 10 9 / L and platelet recovery to 20 × 10 9 / L were 14 days (10 ~ 22 days) and 19 days (10 ~ 68 days) after transplantation, respectively. In 49 cases of successful transplant, 16 cases (32.7%) of acute GVHD occurred, of which 5 cases (Ⅲ. Twenty-four patients (66.7%) had chronic GVHD after 6 months of age, including 5 cases (13.9%) with extensive disease. MMF + CsA + M