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目的 评价自体造血干细胞移植 (ASCT)治疗急性淋巴细胞白血病 (ALL)的疗效及部分影响因素。方法 ASCT治疗ALL患者 3 0例 ,其中第 1次完全缓解 (CR1) 2 4例 ,第 2次完全缓解 (CR2 )或早期复发 6例。预处理方案包括环磷酰胺 (CTX) 1 2 0mg/kg +单次全身照射 (sTBI) 9~ 1 0Gy或 +马利兰 (Bu) 1 6mg/kg或 +马法兰 (Mel) 1 40~ 1 80mg/m2 +阿糖胞苷 (Ara C) 2~ 4g/m2 等。结果 患者移植后均重建造血 ,中位随访时间 50 4 (1 8~ 3 0 4 3 )d ,移植相关死亡 3例 (1 0 .0 % ) ,CR1及CR2 或早期复发期移植者 3年无病生存率分别为 (67.7± 1 0 .3 ) %和 (1 6.7± 1 5.2 ) % (P =0 .0 0 547) ,CR1期移植后有治疗和无治疗者 3年无病生存率分别为 (92 .3± 7.4 ) %和 (50 .0± 1 7.7) % (P =0 .0 1 3 0 )。结论 急性淋巴细胞白血病CR1期ASCT疗效明显高于常规化疗 ,但CR2 以上者移植后复发率很高 ,因此无HLA相匹配供者的患者尽可能在CR1期进行ASCT治疗 ,以获得较好的疗效。另外采用移植后治疗可减少复发率 ,提高疗效。
Objective To evaluate the efficacy and some influencing factors of autologous hematopoietic stem cell transplantation (ASCT) in the treatment of acute lymphoblastic leukemia (ALL). Methods ASCT was used to treat 30 patients with ALL, including the first complete remission (CR1) in 24 patients, the second complete remission (CR2) or early recurrence in 6 patients. Pretreatment regimens include cyclophosphamide (CTX) 120 mg/kg + single body irradiation (sTBI) 9-10 Gy or + maliland (Bu) 16 mg/kg or +Mel 1 40-180 mg/m2 + Ara C 2 to 4 g/m 2 and so on. Results All patients were reconstructed with blood after transplantation. The median follow-up time was 50 4 (18-304)d, and the graft-related deaths were 3 (10.0%). The CR1 and CR2 or early relapsed transplants were free for 3 years. The disease survival rates were (67.7±10.3)% and (16.7±15.2)% (P=0.05047). The 3-year disease-free survival rate of patients with and without treatment after CR1 transplantation was It is (92.3±7.4)% and (50.0%±7.7%)% (P=0.103). Conclusions The curative effect of CR1-phase ASCT in acute lymphoblastic leukemia is significantly higher than that of conventional chemotherapy. However, the recurrence rate after CR2 is higher than that of conventional chemotherapy. Therefore, patients without HLA-matched donors should undergo ASCT as far as possible in CR1 phase to achieve better efficacy. . In addition, post-transplant treatment can reduce the recurrence rate and improve efficacy.