中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2012年
24期
1660-1664
,共5页
孙自敏%刘会兰%耿良权%周晨阳%王兴兵%丁凯阳%童娟%朱薇波%刘欣%王祖贻
孫自敏%劉會蘭%耿良權%週晨暘%王興兵%丁凱暘%童娟%硃薇波%劉訢%王祖貽
손자민%류회란%경량권%주신양%왕흥병%정개양%동연%주미파%류흔%왕조이
移植预处理%脐血干细胞移植%白血病
移植預處理%臍血榦細胞移植%白血病
이식예처리%제혈간세포이식%백혈병
Transplantation conditioning%Cord blood stem cell transplantation%Leukemia
目的 分析采用全身照射(TBI)为主的不含抗胸腺细胞球蛋白(ATG)的清髓性预处理方案进行非血缘脐血移植(UCBT)治疗成人恶性血液病的安全性和疗效.方法 2006年9月至2011年5月,单中心采用不含ATG由TBI、阿糖胞苷(Ara-c)、环磷酰胺(CY)组成的清髓性预处理方案进行UCBT治疗40例成人恶性血液病患者.患者平均年龄(23±6)岁,平均体重(58±9) kg.40例患者中高危难治患者35例(87.5％),进展期进行移植患者15例(37.5％).单份脐血移植23例,双份脐血移植17例.75.0％ (30/40)患者存在HLA 1 ～2个位点不合.移植物抗宿主病(GVHD)预防采用环孢素A联合霉酚酸酯方案.结果 受者输入脐血总有核细胞平均数为(4.1±1.1)×107/kg,CD34+细胞平均数为(2.4±1.0)×105/kg.40例患者全部获得植入,植入率100％.中性粒细胞绝对值≥0.5×109/L的平均时间为(20±5)d,血小板≥20×109/L的平均时间为(38±12)d.40例中23例(57.5％)发生急性GVHD,其中Ⅲ～Ⅳ度4例(10.0％).可评估的35例患者中8例(22.9％)发生慢性GVHD,均为局限型.12.5％ (5/40)患者复发.存活患者中位随访时间19.8(4.6 ～55.0)个月.100 d和1年移植相关病死率分别为15.0％、35.0％.主要死亡原因为严重肺部感染和重度急性GVHD.2年无病生存率和总生存率均为58.8％.疾病进展期与缓解期进行移植的患者2年累计生存率分别为48.6％和63.8％,差异无统计学意义(x2=0.304,P =0.582).结论 采用TBI/Ara-c/CY预处理方案行成人UCBT耐受性好,全部患者均获得稳定植入,降低早期移植相关死亡.该方案用于高危、难治和进展期患者移植后复发率较低,慢性GVHD发生率低并均为局限型,获得较理想的生存率.
目的 分析採用全身照射(TBI)為主的不含抗胸腺細胞毬蛋白(ATG)的清髓性預處理方案進行非血緣臍血移植(UCBT)治療成人噁性血液病的安全性和療效.方法 2006年9月至2011年5月,單中心採用不含ATG由TBI、阿糖胞苷(Ara-c)、環燐酰胺(CY)組成的清髓性預處理方案進行UCBT治療40例成人噁性血液病患者.患者平均年齡(23±6)歲,平均體重(58±9) kg.40例患者中高危難治患者35例(87.5％),進展期進行移植患者15例(37.5％).單份臍血移植23例,雙份臍血移植17例.75.0％ (30/40)患者存在HLA 1 ～2箇位點不閤.移植物抗宿主病(GVHD)預防採用環孢素A聯閤黴酚痠酯方案.結果 受者輸入臍血總有覈細胞平均數為(4.1±1.1)×107/kg,CD34+細胞平均數為(2.4±1.0)×105/kg.40例患者全部穫得植入,植入率100％.中性粒細胞絕對值≥0.5×109/L的平均時間為(20±5)d,血小闆≥20×109/L的平均時間為(38±12)d.40例中23例(57.5％)髮生急性GVHD,其中Ⅲ～Ⅳ度4例(10.0％).可評估的35例患者中8例(22.9％)髮生慢性GVHD,均為跼限型.12.5％ (5/40)患者複髮.存活患者中位隨訪時間19.8(4.6 ～55.0)箇月.100 d和1年移植相關病死率分彆為15.0％、35.0％.主要死亡原因為嚴重肺部感染和重度急性GVHD.2年無病生存率和總生存率均為58.8％.疾病進展期與緩解期進行移植的患者2年纍計生存率分彆為48.6％和63.8％,差異無統計學意義(x2=0.304,P =0.582).結論 採用TBI/Ara-c/CY預處理方案行成人UCBT耐受性好,全部患者均穫得穩定植入,降低早期移植相關死亡.該方案用于高危、難治和進展期患者移植後複髮率較低,慢性GVHD髮生率低併均為跼限型,穫得較理想的生存率.
목적 분석채용전신조사(TBI)위주적불함항흉선세포구단백(ATG)적청수성예처리방안진행비혈연제혈이식(UCBT)치료성인악성혈액병적안전성화료효.방법 2006년9월지2011년5월,단중심채용불함ATG유TBI、아당포감(Ara-c)、배린선알(CY)조성적청수성예처리방안진행UCBT치료40례성인악성혈액병환자.환자평균년령(23±6)세,평균체중(58±9) kg.40례환자중고위난치환자35례(87.5％),진전기진행이식환자15례(37.5％).단빈제혈이식23례,쌍빈제혈이식17례.75.0％ (30/40)환자존재HLA 1 ～2개위점불합.이식물항숙주병(GVHD)예방채용배포소A연합매분산지방안.결과 수자수입제혈총유핵세포평균수위(4.1±1.1)×107/kg,CD34+세포평균수위(2.4±1.0)×105/kg.40례환자전부획득식입,식입솔100％.중성립세포절대치≥0.5×109/L적평균시간위(20±5)d,혈소판≥20×109/L적평균시간위(38±12)d.40례중23례(57.5％)발생급성GVHD,기중Ⅲ～Ⅳ도4례(10.0％).가평고적35례환자중8례(22.9％)발생만성GVHD,균위국한형.12.5％ (5/40)환자복발.존활환자중위수방시간19.8(4.6 ～55.0)개월.100 d화1년이식상관병사솔분별위15.0％、35.0％.주요사망원인위엄중폐부감염화중도급성GVHD.2년무병생존솔화총생존솔균위58.8％.질병진전기여완해기진행이식적환자2년루계생존솔분별위48.6％화63.8％,차이무통계학의의(x2=0.304,P =0.582).결론 채용TBI/Ara-c/CY예처리방안행성인UCBT내수성호,전부환자균획득은정식입,강저조기이식상관사망.해방안용우고위、난치화진전기환자이식후복발솔교저,만성GVHD발생솔저병균위국한형,획득교이상적생존솔.
Objective To retrospectively analyze the curative efficacy of umbilical cord blood transplantation (UCBT) with improved myeloablative conditioning regimen (total body irradiation (TBI)/cytosine arabinoside ( Ara-c)/cyclophosphamide (CY) without antithymocyte globulin ( ATG ) ) in adult patients with hematological malignancies. Methods Forty consecutive adult patients with hematological malignancies received improved myeloablative unrelated CBT at a single center from September 2006 to May 2011.Their average age was ( 23 ± 6 ) years and the average weight ( 58 ± 9 ) kg.Thirty-five ( 87.5％ )patients were high-risk and 15 (37.5％ )at the advanced disease status at pre-transplantation.They received 1 ( n =23 ) or 2 ( n =17 ) cord blood units.Seventy-five percent of them were transplanted with 1/2- human leukocyte antigen mismatched unit.The conditioning regimen consisted of 12 Gy TBI,granulocyte colonystimulating factor (G-CSF) plus Ara-c and CY without ATG. All patients received a combination of cyclosporine (CsA) and mycophenolate mofetil (MMF) for the prophylaxis of graft-versus-host disease (GVHD).Results For the entire group of patients,the average cell doses infused were (4.1 ± 1.1 ) × 107 total nucleated cells/kg and ( 2.4 ± 1.0) × 105 CD34+ cells/kg.All patients acquired engraftment with an implantation rate of 100％.The average time of absolute neutrophil count (ANC) ≥ 0.5 × 109/L was (20 ±5) days and the average time of platelet ≥20 × 109/L was(38 ± 12)days.Acute GVHD occurred in 23 patients( 57.5％ ) and 4 ( 10.0％ ) were of grade Ⅲ - Ⅳ.Chronic GVHD occurred in 22.9％ ( 8/35 ) evaluable patients.Relapse occurred in 12.5％ (5/40) patients.During a median follow-up period of 19.8 ( range 4.6 - 55.0 ) months,the transplantation-related mortality was 15.0％ (6/40) within 100 days and 35.0％ (14/40) within 1 year.The main causes of mortality were pneumonia and severe acute GVHD.Two-year overall survival (05) or disease-free survival was 58.8％ and 58.8％,respectively.Two-year OS for patients with advanced or complete remission disease was 48.6％ and 63.8％,respectively.Conclnsions The TBI/Ara-c/CY myeloablative conditioning regimen is well-tolerated and capable of establishing sustained donor cell engraftment and decreasing the risks of transplant-related death in adults with hematologic malignancies.For the high-risk and advanced patients,it may reduce the occurrences of relapse and chronic GVHD.
