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目的 评价非亲缘异基因骨髓移植 (URD BMT)治疗儿童急性和慢性白血病的临床疗效。方法 6例白血病患儿 ,其中慢性髓系白血病 2例 ,急性淋巴细胞白血病 3例 (第 1次完全缓解 ) ,急性早幼粒细胞白血病 1例 (第 2次完全缓解 ) ,由台湾慈济骨髓捐赠中心提供无关供者骨髓。预处理方案为马利兰 +环磷酰胺 (Bu/Cy2 )方案 ,急性移植物抗宿主病 (aGVHD)预防为霉酚酸酯(MMF)、环孢菌素A(CsA)加氨甲喋呤 (MTX)联合方案 ;以前列素E1预防肝静脉闭塞病 (VOD) ,以巨细胞病毒 (CMV)抗原血症监测和更昔洛韦预防CMV病。供、受者间HLA基因位点型全相合 3例 ,1个基因位点型不合 2例 ,2个基因位点型不合 1例。结果 6例患儿经DNA短串联重复序列多态性分析证明为供髓植入 ,中性粒细胞 >0 5× 10 9/L的中位天数为 14 5 (13～ 18)d ,血小板 >2 0×10 9/L的中位天数为 16 (11～ 2 3)d。发生Ⅱ～Ⅳ度aGVHD 2例 (33% ) ,局限性慢性移植物抗宿主病(cGVHD) 3例 ,未发生广泛性cGVHD。中位随访时间 4 12 (187～ 1338)d ,全部患儿均无病生存。结论非亲缘异基因骨髓移植是治疗儿童急性和慢性白血病的有效方法。
Objective To evaluate the clinical efficacy of non-related allogeneic bone marrow transplantation (URD BMT) in children with acute and chronic leukemia. Methods Six children with leukemia, including 2 chronic myeloid leukemia, 3 acute lymphoblastic leukemia (first complete remission) and 1 acute promyelocytic leukemia (complete remission 2), were recruited from Taiwan Tzu Chi bone marrow Donor centers donate donor bone marrow. The pretreatment regimen was the combination of Marilan + cyclophosphamide (Bu / Cy2) and the prevention of aGVHD with mycophenolate mofetil (MMF), cyclosporine A (CsA) plus methotrexate (MTX) ; Preoprost E1 prevents hepatic veno-occlusive disease (VOD), monitors cytomegalovirus (CMV) antigenemia and prevents ganciclovir from CMV disease. The donor and recipient HLA loci were all matched in 3 cases, with 1 gene locus incompatibility in 2 cases and 2 loci in 1 case. Results Six cases were proved by DNA short tandem repeat polymorphism analysis. The median number of neutrophils> 0 5 × 10 9 / L was 14 5 (13-18 days), platelet count> The median days for 2 0 × 10 9 / L were 16 (11 ~ 23) days. Two (33%) patients with stage Ⅱ-Ⅳ aGVHD and 3 patients with localized chronic graft-versus-host disease (cGVHD) did not develop extensive cGVHD. The median follow-up time was 4 12 (187 ~ 1338) d, all children were disease-free survival. Conclusion Non-related allogeneic bone marrow transplantation is an effective treatment for children with acute and chronic leukemia.