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目的 评价异基因造血干细胞移植(allo-HSCT)治疗恶性血液病的疗效及并发症。方法 52例恶性血液病患者,其中亲缘异基因移植40例,非亲缘移植12例。预处理方案髓系白血病为改良BUCY;急性淋巴细胞白血病(ALL)和合并中枢神经系统白血病(CNS-L)的髓系白血病以全身照射(TBI)+环磷酰胺(CTX)为主的化疗;重型再生障碍性贫血(SAA)以氟达拉宾、CTX及抗淋巴细胞球蛋白(ALG)方案。40例亲缘异基因移植均采用环胞菌素A(CSA)加短程氨甲喋呤(MTX),12例非亲缘移植采用骁悉(MMF)、CSA加MTX联合方案预防移植物抗宿主病(GVHD)。结果 均较顺利地完成预处理及移植治疗。移植后15 d(中位时间)造血重建。GVHD发生率急性Ⅰ~Ⅱ度30％,Ⅲ~Ⅳ度13.4％。随访2~17个月,荧光标记STR-PCR定量检测,75％患者供体细胞嵌合率(DM)>90％。50例非复发状况移植,至今存活40例,生存率(OS)达80％,移植相关病死率20％。结论 allo-HSCT能有效地治疗或根治恶性血液病。
Objective To evaluate the efficacy and complications of allo-HSCT in the treatment of hematologic malignancies. Methods Fifty-two patients with hematologic malignancies, of which 40 were allogeneic and 12 were unrelated. Pretreatment regimen Myeloid leukemia is a chemotherapy based on total body irradiation (TBI) + cyclophosphamide (CTX) for myeloid leukemia that modifies BUCY; acute lymphoblastic leukemia (ALL); and central nervous system leukemia (CNS-L) Severe Aplastic Anemia (SAA) with fludarabine, CTX and anti-lymphocyte globulin (ALG) program. 40 cases of allogeneic allogeneic transplantation were treated with CSA and MTX, and 12 unrelated patients were treated with MMF and CSA combined with MTX in the prevention of graft versus host disease (GVHD). The results were successfully completed pretreatment and transplantation. 15 days after transplantation (median time) hematopoietic reconstitution. The incidence of GVHD was 30% acute Ⅰ ~ Ⅱ, 13.4% Ⅲ ~ Ⅳ. The patients were followed up for 2 to 17 months. Quantitative detection by fluorescent-labeled STR-PCR showed that donor chimerism rate (DM) was> 90% in 75% of the patients. 50 cases of non-recurrence of graft, so far survival of 40 cases, the survival rate (OS) of 80%, transplant-related mortality of 20%. Conclusion Allo-HSCT can effectively treat or cure hematologic malignancies.