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目的:探讨HLA半相合外周血造血干细胞移植(peripheral blood stem cell transplantation,PBSCT)治疗急性白血病的效果及安全性。方法:4例急性白血病行HLA半相合PBSCT,其中急性淋巴细胞白血病2例,急性非淋巴细胞白血病2例,移植时均处于完全缓解状态。HLA配型1、2个位点不合各1例,3个位点不合2例。预处理方案由全身照射或白消安、阿糖胞苷、环磷酰胺、甲基洛莫司汀组成。移植物抗宿主病(graft versus host disease,GVHD)的预防采用环胞素、甲氨蝶呤、麦考酚吗乙酯、抗胸腺细胞球蛋白四联方案。结果:4例均获得造血功能重建。2例出现Ⅰ度急性GVHD,2例出现Ⅱ度急性GVHD。1例并发巨细胞病毒间质性肺炎,2例并发真菌肺炎。至今3例无病存活29、15和2个月,1例死亡。结论:HLA半相合PBSCT疗效较好、安全可行,为无HLA完全相合供者的白血病患者提供了新的治疗手段,但要特别注意移植后病毒和真菌感染的防治。
Objective: To investigate the efficacy and safety of HLA haploidentical peripheral blood stem cell transplantation (PBSCT) in the treatment of acute leukemia. Methods: Four patients with acute leukemia underwent HLA haploidentical PBSCT. Among them, 2 were acute lymphoblastic leukemia and 2 were acute non-lymphocytic leukemia. All of them were in complete remission at the time of transplantation. HLA matching 1 and 2 loci in 1 case, 3 cases not in 2 cases. Pretreatment program by the whole body irradiation or busulfan, cytarabine, cyclophosphamide, methyl lomustine composition. Prevention of graft versus host disease (GVHD) with cyclosporine, methotrexate, mycophenolate mofetil, anti-thymocyte globulin quadruple protocol. Results: All the 4 cases were reconstructed with hematopoietic function. Two cases had grade A acute GVHD and two cases had grade II acute GVHD. One patient had cytomegalovirus interstitial pneumonia and two patients had fungal pneumonia. To date, three patients died of disease at 29, 15 and 2 months without disease. Conclusion: HLA haploidentical PBSCT is effective, safe and feasible, and provides a new treatment for patients with leukemia without HLA matched donor. However, special attention should be paid to the prevention and treatment of virus and fungal infection after transplantation.