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目的:探索半相合未去除T细胞骨髓移植治疗慢性粒细胞白血病的可行性。方法:4例慢性粒细胞白血病患者接受HLA1或2个位点不相合亲缘骨髓移植。用阿糖胞苷、环磷酰胺和全身照射进行预处理,供者应用GCSF250μg/d,连用7d后采髓。移植物抗宿主病(GVHD)预防除用环孢菌素A(CsA)和甲氨蝶呤(MTX)外,在移植前第4天～第1天用抗胸腺细胞球蛋白ATG(兔抗)2.5mg/(kg·d),移植后第7天开始加用霉酚酸酯1.0g/d。结果:患者移植后均获得造血重建,中性粒细胞>0.5×109/L和血小板>20×109/L的中位时间分别是12.5(10～14d)和22d(18～25d)。4例患者发生急性Ⅰ度GVHD,其中1例2个位点不相合者进展为急性肠道和肝脏Ⅳ度GVHD,于+81d合并感染死亡。1例发生迟发性出血性膀胱炎。中位随访时间20个月(5～25个月)。无病存活3例,其中2例存活在1年以上。结论:供者应用GCSF后采髓,多种免疫抑制剂联合应用的HLA不全相合未去除T细胞骨髓移植,在治疗慢性粒细胞白血病过程中,有效地降低了急性重症GVHD发生,提高了无病生存。
Objective: To explore the feasibility of treatment of chronic myeloid leukemia by haploidentical non-T cell bone marrow transplantation. Methods: Four patients with chronic myeloid leukemia received HLA1 or two loci that did not coincide with their relatives. With cytarabine, cyclophosphamide and systemic irradiation for pretreatment, the donor application of GCSF250μg / d, once every 7d after extraction of the pulp. Graft Versus Host Disease (GVHD) Prevention Antithymocyte globulin ATG (rabbit anti) was administered on day 4 to day 1 before transplantation except cyclosporine A (CsA) and methotrexate (MTX) 2.5mg / (kg · d), on the 7th day after transplantation, mycophenolate mofetil 1.0g / d was added. Results: The hematopoietic reconstitution was obtained in all patients. The median time of neutrophil> 0.5 × 109 / L and platelet count> 20 × 109 / L were 12.5 (10 ~ 14d) and 22d (18 ~ 25d) respectively. Four patients developed acute grade I GVHD. One of the two cases of disagreement progressed to grade IV GVHD of acute intestinal and hepatic failure, and died of infection at + 81 d. One patient developed delayed hemorrhagic cystitis. The median follow-up time was 20 months (range 5 to 25 months). No disease-free survival in 3 cases, of which 2 survived in more than 1 year. CONCLUSION: Donor’s application of GCSF after extraction of the marrow and immunosuppressive agents in combination with HLA-incompatible T-cell non-cancerous bone marrow transplantation has effectively reduced the incidence of acute severe GVHD and improved disease-free in the treatment of chronic myeloid leukemia survive.