CAJ | 학술논문

背景:造血干细胞移植成功的主要障碍是移植后的各种并发症,早期并发症主要与预处理有关.找出合理的剂量和新的高散低毒的预处理方案是提高造血干细胞移植成功率的关键.目的:了解以烷化剂为主的联合化疗作预处理,进行造血干细胞移植治疗恶性血液病的相关毒性和移植效果.设计:观察对比实验.地点:徐州医学院附属医院血液科.对象:选择1997-07/2006-02在徐州医学院附属医院住院的45例白血病及淋巴瘤患者,男31例,女14例,年龄7～52岁,中位年龄31岁.移植时病程5～17个月,平均8个月.方法:对45例白血病及淋巴瘤缓解期患者进行骨髓及外周血干细胞移植,预处理方案为以烷化剂为主的联合化疗,髓外毒性分级采用Bearman等制订的标准,预处理相关毒性分5个级别,即由无毒性(0级)至致死性毒性(Ⅳ级).统计分析完全缓解率、完全缓解时间、复发率和无病生存期.主要观察指标:各脏器预处理相关毒性发生情况.结果:①5例无任何毒性发生,最大毒性为Ⅲ级者占13%(6/45).各脏器预处理相关毒性大多数为Ⅰ～Ⅱ级,严重的预处理相关毒性Ⅲ级不多见.在Ⅰ～Ⅱ级预处理相关毒性中口腔黏膜溃疡和胃肠道毒性发生率较高,分别为73%(33/45)和51%(23/45),经治疗后短期内恢复;心脏毒性发生率低,均为Ⅰ级,多为心动过速和ST-T改变;肝脏预处理相关毒性,除2例肝静脉闭塞病外,多表现为转氨酶增高,4例出血性膀胱炎,其中1例为迟发性出血性膀胱炎.肾、肺和中枢神经系统预处理相关毒性少见.②移植后43例患者造血功能获得重建,植入失败死亡2例(4%).中位随访时间37(8～102)个月,复发10例及移植相关并发症死亡5例,28例仍长期无病生存(62.2%).100 d内移植相关死亡原因主要为急性移植物抗宿主病,巨细胞病毒性间质性肺炎,侵袭性感染,多脏器功能衰竭和早期复发.结论:烷化剂为主的预处理方案进行造血干细胞移植治疗白血病和淋巴瘤相关毒性轻,患者耐受好. 揹景:造血榦細胞移植成功的主要障礙是移植後的各種併髮癥,早期併髮癥主要與預處理有關.找齣閤理的劑量和新的高散低毒的預處理方案是提高造血榦細胞移植成功率的關鍵.目的:瞭解以烷化劑為主的聯閤化療作預處理,進行造血榦細胞移植治療噁性血液病的相關毒性和移植效果.設計:觀察對比實驗.地點:徐州醫學院附屬醫院血液科.對象:選擇1997-07/2006-02在徐州醫學院附屬醫院住院的45例白血病及淋巴瘤患者,男31例,女14例,年齡7～52歲,中位年齡31歲.移植時病程5～17箇月,平均8箇月.方法:對45例白血病及淋巴瘤緩解期患者進行骨髓及外週血榦細胞移植,預處理方案為以烷化劑為主的聯閤化療,髓外毒性分級採用Bearman等製訂的標準,預處理相關毒性分5箇級彆,即由無毒性(0級)至緻死性毒性(Ⅳ級).統計分析完全緩解率、完全緩解時間、複髮率和無病生存期.主要觀察指標:各髒器預處理相關毒性髮生情況.結果:①5例無任何毒性髮生,最大毒性為Ⅲ級者佔13%(6/45).各髒器預處理相關毒性大多數為Ⅰ～Ⅱ級,嚴重的預處理相關毒性Ⅲ級不多見.在Ⅰ～Ⅱ級預處理相關毒性中口腔黏膜潰瘍和胃腸道毒性髮生率較高,分彆為73%(33/45)和51%(23/45),經治療後短期內恢複;心髒毒性髮生率低,均為Ⅰ級,多為心動過速和ST-T改變;肝髒預處理相關毒性,除2例肝靜脈閉塞病外,多錶現為轉氨酶增高,4例齣血性膀胱炎,其中1例為遲髮性齣血性膀胱炎.腎、肺和中樞神經繫統預處理相關毒性少見.②移植後43例患者造血功能穫得重建,植入失敗死亡2例(4%).中位隨訪時間37(8～102)箇月,複髮10例及移植相關併髮癥死亡5例,28例仍長期無病生存(62.2%).100 d內移植相關死亡原因主要為急性移植物抗宿主病,巨細胞病毒性間質性肺炎,侵襲性感染,多髒器功能衰竭和早期複髮.結論:烷化劑為主的預處理方案進行造血榦細胞移植治療白血病和淋巴瘤相關毒性輕,患者耐受好.
배경:조혈간세포이식성공적주요장애시이식후적각충병발증,조기병발증주요여예처리유관.조출합리적제량화신적고산저독적예처리방안시제고조혈간세포이식성공솔적관건.목적:료해이완화제위주적연합화료작예처리,진행조혈간세포이식치료악성혈액병적상관독성화이식효과.설계:관찰대비실험.지점:서주의학원부속의원혈액과.대상:선택1997-07/2006-02재서주의학원부속의원주원적45례백혈병급림파류환자,남31례,녀14례,년령7～52세,중위년령31세.이식시병정5～17개월,평균8개월.방법:대45례백혈병급림파류완해기환자진행골수급외주혈간세포이식,예처리방안위이완화제위주적연합화료,수외독성분급채용Bearman등제정적표준,예처리상관독성분5개급별,즉유무독성(0급)지치사성독성(Ⅳ급).통계분석완전완해솔、완전완해시간、복발솔화무병생존기.주요관찰지표:각장기예처리상관독성발생정황.결과:①5례무임하독성발생,최대독성위Ⅲ급자점13%(6/45).각장기예처리상관독성대다수위Ⅰ～Ⅱ급,엄중적예처리상관독성Ⅲ급불다견.재Ⅰ～Ⅱ급예처리상관독성중구강점막궤양화위장도독성발생솔교고,분별위73%(33/45)화51%(23/45),경치료후단기내회복;심장독성발생솔저,균위Ⅰ급,다위심동과속화ST-T개변;간장예처리상관독성,제2례간정맥폐새병외,다표현위전안매증고,4례출혈성방광염,기중1례위지발성출혈성방광염.신、폐화중추신경계통예처리상관독성소견.②이식후43례환자조혈공능획득중건,식입실패사망2례(4%).중위수방시간37(8～102)개월,복발10례급이식상관병발증사망5례,28례잉장기무병생존(62.2%).100 d내이식상관사망원인주요위급성이식물항숙주병,거세포병독성간질성폐염,침습성감염,다장기공능쇠갈화조기복발.결론:완화제위주적예처리방안진행조혈간세포이식치료백혈병화림파류상관독성경,환자내수호.
BACKGROUND: The principal deterrent to the success for hematopoietic stem cell transplantation (HSCT) is the complications after transplantation. The complications are associates with the conditioning regimens in the early stage. The highly-effective preparative regimens of proper dose and low-toxicity are the key to the successful HSCT.OBJECTIVE: To evaluate the curative effects and regimen related toxicity (RRT) of high-dose alkylating-agent-based chemotherapy as conditioning regimens for HSCT in the patients with hematological malignancies.DESIGN: Controlled study with observation.SETTING: Department of Hematology, Affiliated Hospital of Xuzhou Medical College.PARTICIPANTS: A total of 45 patients with leukemia and lymphoma hospitalized at Affiliated Hospital of Xuzhou Medical College from July 1997 to February 2006 were enrolled, including 31 males and 14 females. The median age was 31 years (from 7 to 52 years). The median course was 8 months (from 5 to 17 months) until transplantation.METHODS: Totally 45 patients with leukemia and lymphoma approached or got complete remission were treated by bone marrow transplantation and peripheral blood stem cell transplantation with preparative regimens of high-dose alkylating-agent-based chemotherapy. RRT was graded according to Bearman proposal, from grade 0 (no toxicity) to grade Ⅳ (fatal toxicity). The period of hematopoietic reconstitution, the rates of complete remission and relapse and disease-free survival were statistically observed in transplant recipients.MAIN OUTCOME MEASURES: Occurrence of RRT as conditioning regimens.RESULTS: ①Five patients did not show any toxicity. The greatest toxicity of grade Ⅲ was uncommon (13%, 6/45). Most of the cases with RRT were in grade Ⅰ - Ⅱ and severe oases in grade Ⅲ were rare. In grade Ⅰ - Ⅱ, stomatocace and gastrointestinal toxicity were common respectively of 73% (33/45) and 51% (23/45) which were recovered in short time after treatment; Heart toxicity was rare and only in grade Ⅰ, most of which were tachyoardia and changes of ST-T shape. The increase of transaminase was common in the clinical manifestations of liver RRT except two cases of HVOD.There were four oases of HC, in which one was delayed. RRT on kidney, lungs and CNS was uncommon. ②Totally 43 patients engrafted gained hematopoietic reconstitution, 2 patients died of implant failure (4%). Within the median follow-up period of 37 (8-102) months, 10 patients relapsed, 5 patients died of transplantation-related complications and 28 patients were alive in a disease-free situation (62.2%). The cause of death within 100 days after transplantation was ordinal as acute graft-versus-host disease (GVHD), cytomegalovirus (CMV) interstitial pneumonia, disseminated infections,multiple organ failure and early relapses.CONCLUSION: Alkylating-agent-based conditioning regimens may be well tolerated with low toxicities for HSCT in leukemia and lymphoma.