CAJ | 학술논문

目的：观察交替半身照射综合方案对急性白血病残留病的治疗效果。方法：对 9例急性白血病患者经标准化疗缓解后，进行强化疗预处理（环磷酰胺 120 mg/kg,）＋交替半身照射（上半身照射 7～ 7.5 Gy，下半身照射 8～ 9 Gy）＋过激免疫治疗（结核菌素纯蛋白衍生物， rhIL-2激活的自体骨髓细胞）的综合方案治疗；观察指标：动态观察治疗前后的血象、骨髓象、骨髓 GM-CFU改变；采用筑巢式 PCR检测残留病的方法和 12-ο -十四烷酰佛波醋酸酯 -13（ 12-ο -tetradecanoyl-phorbol-13-acetate,TPA）诱导分化试验观察治疗效果。结果： 9例患者血象、骨髓象、骨髓 GM-CFU于治疗完成后 2-3周均能自行恢复至正常水平，无严重毒副作用。筑巢式 PCR检测表明，本组残留病 4例转为阴性， 2例弱阳性， 3例阳性。 9例患者经该方案治疗后均未作巩固化疗，现最长已持续缓解 27个月，最短为 4个月，中位缓解期 1.5个月。结论：交替半身照射综合方案，对残留白血病有良好的治疗效果。该方案毒副作用轻，费用低，可能有推广应用前景。
목적：관찰교체반신조사종합방안대급성백혈병잔류병적치료효과。방법：대 9례급성백혈병환자경표준화료완해후，진행강화료예처리（배린선알 120 mg/kg,）＋교체반신조사（상반신조사 7～ 7.5 Gy，하반신조사 8～ 9 Gy）＋과격면역치료（결핵균소순단백연생물， rhIL-2격활적자체골수세포）적종합방안치료；관찰지표：동태관찰치료전후적혈상、골수상、골수 GM-CFU개변；채용축소식 PCR검측잔류병적방법화 12-ο -십사완선불파작산지 -13（ 12-ο -tetradecanoyl-phorbol-13-acetate,TPA）유도분화시험관찰치료효과。결과： 9례환자혈상、골수상、골수 GM-CFU우치료완성후 2-3주균능자행회복지정상수평，무엄중독부작용。축소식 PCR검측표명，본조잔류병 4례전위음성， 2례약양성， 3례양성。 9례환자경해방안치료후균미작공고화료，현최장이지속완해 27개월，최단위 4개월，중위완해기 1.5개월。결론：교체반신조사종합방안，대잔류백혈병유량호적치료효과。해방안독부작용경，비용저，가능유추엄응용전경。
Objective： This study was designed to investigate the effect of alternative half-body irradiation combined scheme on treatment for the patients with residual disease of acute leukemia. Methods： Five patients with acute leukemia were treated with combination of condition treatment [cytoxan (CTX) 120 mg/kg], alternative half-body irradiation (upper body irradiation with 7-7.5 gray and lower body irradiation with 8-9 gray), and immunotherapy (BCG-PPD, rhIL-2 activing auto-bone marrow cells) after remission with standard chemotherapy. Dynamic changes of blood and bone marrow figures, granulocyte-macrophage colony-forming unit (GM-CFU) of bone marrow before and after treatment were observed. Reverse transcriptase polymerase chain reaction (RT-PCR) and 12-ο -tetradecanoyl-phorbol-13-acetate (TPA) induced differentiation assay were used to evaluate the effect. Results： In all 9 cases, blood and bone marrow figures, GM-CFU numbers of bone marrow were automatically recovered to normal level at 2-3 weeks after treatment without severe side effect. The detection of residual disease with RT-PCR at 6 months after treatment showed that 4 negative cases, 2 weak positive cases, and 3 positive cases had recurred at 27 and 4 month, respectively. The median remission time was 1.5 months. Conclusion： The alternative half-body irradiation combined scheme is markedly effective to leukemia. Its side effect was very slight. The cost was more lower and it is easy to implement.