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目的:了解非清髓性造血干细胞移植(NST)的植入和初步临床疗效。方法:NST治疗恶性血液病18例,清髓性外周血干细胞移植(PBSCT)治疗24例。预处理方案:NST组主要包括单用马利兰(Bu)16mg/kg或Bu12mg/kg加阿糖胞苷(Arac)/高三尖杉酯碱(HHT)或一般联合化疗;清髓性PBSCT组包括环磷酰胺(Cy)120mg/kg加单次全身照射(STBI)9～10Gy或Bu16mg/kg/马法兰(Mel)140～160mg/m2加Arac。结果:NST组18例全部重建造血,移植相关死亡3例(16.67%);3年无病生存率(DFS)72.22%±10.56%,中位随访时间为2062(90～2730)d。清髓性PBSCT组造血重建23例,移植相关死亡4例(16.67%);3年DFS70.83%±9.28%,中位随访时间为1936(19～2700)d,两组差异无统计学意义(P>0.05)。NST组外周血象受抑程度明显减轻,WBC最低为0.3(0.2～0.9)×109/L,而清髓性PBSCT组16/24WBC降至0。NST组发生急性移植物抗宿主病(aGVHD)15(83.33%)例、可评估慢性移植物抗宿主病(cGVHD)16例(88.89%),均明显高于清髓性PBSCT组的6例(25%)与cGVHD13例(54.17%)。NST组发热13例(72.22%)而清髓性PBSCT组24例均有发热(100%),感染发生率和持续时间前者明显少于后者(P<0.05)。结论:NST与清髓性PBSCT疗效相当,造血重建快,且其外周血象受抑程度低,治疗安全、有效。
Objective: To understand the implantation and primary clinical efficacy of non-myeloablative hematopoietic stem cell transplantation (NST). Methods: 18 cases of hematologic malignancies were treated with NST and 24 cases of myeloablative stem cell transplantation (PBSCT). Pretreatment regimen: The NST group consisted of prednisolone (Bu) alone 16 mg / kg or Bu12 mg / kg plus Arac / homoharringtonine (HHT) or general combination chemotherapy; Arac was treated with 120 mg / kg of phosphoramide (Cy) and 9 to 10 Gy of single-body-whole-body irradiation (STBI) or Bu16 mg / kg / 140 to 160 mg / m2 of melphalan. Results: All of the 18 patients in the NST group had hematopoietic reconstitution and 3 died of graft-related death (16.67%). The 3-year disease-free survival rate was 72.22% ± 10.56%. The median follow-up time was 2062 (90-2730) d. There were 23 cases of hematopoietic reconstitution in myeloablative PBSCT group and 4 cases of graft-related death (16.67%). The 3-year DFS was 70.83% ± 9.28%, and the median follow-up time was 1936 (19-2700) days. There was no significant difference between the two groups (P> 0.05). The degree of suppression of peripheral blood was significantly reduced in NST group, with the lowest WBC of 0.3 (0.2-0.9) × 109 / L, while the 16 / 24WBC of myeloablative PBSCT group decreased to 0. 16 cases (88.89%) of 16 patients with acute graft-versus-host disease (aGVHD) in NST group were able to evaluate chronic graft versus host disease (cGVHD), which were significantly higher than those in 6 cases (25% ) And 13 cases of cGVHD (54.17%). In the NST group, 13 cases (72.22%) had fever and 24 cases in the myeloablative PBSCT group had fever (100%). The incidence and duration of infection were significantly lower than those in the latter (P <0.05). Conclusion: NST and myeloablative PBSCT have the same curative effect, quick hematopoietic reconstitution and low suppression of peripheral blood as well as safe and effective treatment.