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目的探索半相合未去除T细胞骨髓移植联合中药治疗白血病的可行性。方法4例慢性粒细胞白血病和4例急性髓性白血病患者接受人类白细胞抗原(HLA)1—3个位点不相合骨髓移植,用阿糖胞苷、环磷酰胺和全身照射或马利兰进行预处理。供者每天应用粒细胞集落刺激因子(G-CSF)250μg,连用7天后采髓。移植物抗宿主病(GVHD)预防除用环孢霉素A(CSA)和甲氨喋呤(MTX)外,在移植前4天至前1天每天用抗胸腺细胞球蛋白(ATG)2·5mg/kg,移植后第7天开始每天加用骁悉(霉酚酸酯)1·0g,骨髓输入后采用益气养阴、健脾和胃等中药治疗。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天(10~14天)和20天(18~25天)。8例中7例有程度不一的皮肤GVHD,其中1例为Ⅳ度皮肤GVHD,2例并发Ⅳ度急性肠道GVHD,1例在81天合并感染死亡,1例在46天自动出院,2例出现出血性膀胱炎;中位随访时间18个月(2~32个月),无病存活6例。结论供者应用G-CSF后采髓,多种免疫抑制剂联合中药治疗HLA不全相合未去除T细胞骨髓移植,在治疗白血病过程中,有效的降低了急性重症GVHD发生,提高了无病生存率。
Objective To explore the feasibility of using half-matched non-T cell bone marrow transplantation combined with traditional Chinese medicine in the treatment of leukemia. METHODS: Four patients with chronic myeloid leukemia and four patients with acute myeloid leukemia were treated with one to three HLA mismatched bone marrow transplants and were pretreated with cytarabine, cyclophosphamide, and whole body irradiation, or with Maryland . Donor daily application of granulocyte colony stimulating factor (G-CSF) 250μg, once every 7 days after the extraction of the pulp. Prevention of graft-versus-host disease (GVHD) Prevention of graft-versus-host disease (GVHD) with anti-thymocyte globulin (ATG) 2 5mg / kg, the first day after transplantation 7 days every day plus Xiao Xiong (mycophenolate mofetil) 1.0 g, bone marrow input after the use of Qi and Yin, spleen and stomach and other traditional Chinese medicine treatment. Results The median time of hematopoietic reconstitution, neutrophil count> 0.5 × 109 / L and platelet count> 20 × 109 / L were 12 days (10-14 days) and 20 days day). Seven of the 8 patients had varying degrees of skin GVHD, of which 1 had grade IV skin GVHD, 2 had IV acute GVHD, 1 had died of infection on day 81, 1 had had spontaneous discharge on day 46, 2 had had spontaneous discharge on day 46, Cases of hemorrhagic cystitis; median follow-up time of 18 months (2 to 32 months), disease-free survival in 6 cases. Conclusions After G-CSF is taken by the donor, multiple mycophenolate mimicking immunosuppressants combined with traditional Chinese medicine can effectively reduce the incidence of acute severe GVHD and improve the disease-free survival rate in the treatment of leukemia .