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目的:探讨异基因外周血干细胞(allo-PBSC)动员及移植治疗白血病的疗效。方法:2例患者诊断分别为急非淋白血病M_(2a)及慢性粒细胞白血病,预处理方案主要为大剂量环磷酰胺加全身照射。主要用粒细胞集落刺激因子(G-CSF)8mg左右·kg~(-1)·d~(-1)连续5天对异基因外周干细胞移植(allo-PBSCT)的供者进行动员,第5天及第6天(即相当于移植的-1天及0天)用COBESpectra血液细胞分离机采集单个核细胞(MNC),两次采集的MNC悬液均于0天由静脉输给患者。例1输入的MNC及幼粒细胞数分别为6.07×10~8/kg及1.38×10~8/kg,例2为8.98×10~8/kg及1.76×10~8/kg。移植后给予预防移植物抗宿主病(GVHD)等措施。结果:2例均迅速恢复造血功能,例1于+110天血型完全转为供者型,例2骨髓染色体核型完全转变为供者型(46XX),Ph~1染色体由阳性转为阴性。现已分别随访106及133天,骨髓仍持续缓解。结论:allo-PBSCT有造血功能恢复快,不需采集骨髓等优点。同时我们还对移植的剂量标准提出了新的看法并进行了讨论。
Objective: To investigate the efficacy of allogeneic peripheral blood stem cell (allo-PBSC) mobilization and transplantation in the treatment of leukemia. Methods: Two patients were diagnosed as acute non-leaching leukemia M_(2a) and chronic myeloid leukemia. The pretreatment regimen was mainly high-dose cyclophosphamide plus whole body irradiation. The mobilization of donors of allogeneic peripheral stem cell transplantation (allo-PBSCT) was performed for 5 consecutive days with granulocyte colony-stimulating factor (G-CSF) approximately 8 mg·kg -1 ·d -1 . Mononuclear cells (MNCs) were collected on the day and on day 6 (equivalent to -1 day and 0 day of transplantation) using a COBE Spectra blood cell separator, and the two collected MNC suspensions were intravenously delivered to the patient on day 0. The number of imported MNC and myelocytes in Example 1 was 6.07×10~8/kg and 1.38×10~8/kg, respectively, while those in Example 2 were 8.98×10~8/kg and 1.76×10~8/kg. After transplantation, prevention of graft-versus-host disease (GVHD) and other measures are given. Results: The hematopoietic function was rapidly restored in 2 cases. In case 1, the blood type was completely converted to donor type on +110 days. In case 2, the karyotype of bone marrow was completely converted to donor type (46XX), and the Ph~1 chromosome changed from positive to negative. Follow-up has been followed up for 106 and 133 days, respectively, and the bone marrow remains in remission. Conclusion: Allo-PBSCT has the advantages of rapid recovery of hematopoietic function without the need to collect bone marrow. At the same time, we also proposed new views on the dose standard for transplantation and discussed them.