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目的 :评价异基因外周血造血干细胞移植 (Allo- PBSCT)治疗白血病的疗效 ,同时比较 ABO血型相合与不相合移植以及两种移植物抗宿主病 (GVHD)预防方案。方法 :用 Allo- PBSCT治疗白血病 5 0例 (急性 2 9例 ,慢性 2 1例 ) ,其中 ABO血型相合 30例 ,不相合 2 0例。 PBSC动员采用 G- CSF或 G- CSF+GM- CSF皮下注射 5 d;预处理采用 CTX+VP16 +TBI或CTX+TBI方案 ;GVHD预防采用常规环孢素 A(Cs A) +短程甲氨蝶呤 (MTX)和霉酚酸酯 (MMF)联合 Cs A +短程 MTX两种方案。 结果 :本组患者经 Allo- PBSCT均获得造血功能重建。 ABO血型相合移植与不相合移植比较 ,后者血红蛋白恢复较慢 (P<0 .0 5 ) ,中性粒细胞和血小板恢复两者无差异 (P>0 .0 5 )。本组发生 a GVHD 2 0例 (4 0 %) ,其中 度以上 9例 (18%)。生存 6个月以上者发生 c GVHD 2 2例 (6 6 .6 7%) ,其中广泛性 11例 (33.33%)。 MMF联合 Cs A和 MTX方案与常规 Cs A联合MTX方案相比 ,前者可减少 a GVHD发生率 (P<0 .0 5 ) ,虽两者 c GVHD总发生率无差异 (P>0 .0 5 ) ,但前者广泛性 c GVHD明显减少 (P<0 .0 5 ) ;本组患者中位随访 30个月存活 33例 ,移植后 3年无病生存率为 6 6 %;GVHD合并感染和间质性肺炎是主要死因。结论 :ABO血型不合不影响移植 ,但移植后血
OBJECTIVE: To evaluate the efficacy of allogeneic peripheral blood stem cell transplantation (Allo-PBSCT) in the treatment of leukemia, and to compare ABO blood grouping with incompatible transplantation and two GVHD prophylaxis plans. Methods: Allo PBSCT was used to treat 50 cases of leukemia (29 cases in acute and 21 cases in chronic phase). There were 30 matched cases of ABO blood group and 20 cases of unmatched cases. PBSC mobilization with G-CSF or G-CSF + GM-CSF subcutaneously for 5 days; pretreatment with CTX + VP16 + TBI or CTX + TBI regimen; GVHD prophylaxis with conventional cyclosporine A (Cs A) (MTX) and mycophenolate mofetil (MMF) combined with Cs A + short-term MTX two programs. Results: Hematopoietic reconstructions were obtained in Allo PBSCT patients in this study. The hemoglobin recovery in the latter group was slower than that in the non-matched ABO group (P <0.05). There was no difference in the neutrophil and platelet recovery (P> 0.05). A group of 20 cases of GVHD (40%), of which more than 9 cases (18%). Survival of more than 6 months of cGVHD 2 2 cases (66.76%), of which 11 cases were extensive (33.33%). Compared with conventional CsA and MTX, MMF combined with CsA and MTX decreased the incidence of aGVHD (P <0.05), although there was no difference in the overall incidence of cGVHD between the two groups (P> 0.05) ), But the former had a significant decrease of GVHD (P <0.05). The median follow-up of 30 months was 33 cases, and the 3-year disease-free survival rate was 66% after GVHD. Hypothyroidism is the leading cause of death. Conclusion: ABO blood group does not affect the transplant, but the blood after transplantation