第二军医大学学报
第二軍醫大學學報
제이군의대학학보
ACADEMIC JOURNAL OF SECOND MILITARY MEDICAL UNIVERSITY
2002年
9期
933-938
,共6页
王健民%章卫平%宋献民%楼敬伟%童书鹏%杨建民%闵碧荷%李红梅%丁晓勤%钱宝华%肖作平
王健民%章衛平%宋獻民%樓敬偉%童書鵬%楊建民%閔碧荷%李紅梅%丁曉勤%錢寶華%肖作平
왕건민%장위평%송헌민%루경위%동서붕%양건민%민벽하%리홍매%정효근%전보화%초작평
外周血%造血干细胞移植%异基因%白血病%移植物抗宿主病
外週血%造血榦細胞移植%異基因%白血病%移植物抗宿主病
외주혈%조혈간세포이식%이기인%백혈병%이식물항숙주병
peripheral blood%hematopoietic stem cell transplantation%allogeneic%leukemia%graft versus host disease
目的:评价异基因外周血造血干细胞移植(Allo-PBSCT)治疗白血病的疗效,同时比较ABO血型相合与不相合移植以及两种移植物抗宿主病(GVHD)预防方案.方法:用Allo-PBSCT治疗白血病50例(急性29例,慢性21例),其中ABO血型相合30例,不相合20例.PBSC动员采用G-CSF或G-CSF+GM-CSF皮下注射5 d;预处理采用CTX+VP16+TBI或CTX+TBI方案;GVHD预防采用常规环孢素A(CsA)+短程甲氨蝶呤(MTX)和霉酚酸酯(MMF)联合CsA+短程MTX两种方案.结果:本组患者经Allo-PBSCT均获得造血功能重建.ABO血型相合移植与不相合移植比较,后者血红蛋白恢复较慢(P<0.05),中性粒细胞和血小板恢复两者无差异(P>0.05).本组发生aGVHD 20例(40%),其中Ⅱ度以上9例(18%).生存6个月以上者发生cGVHD 22例(66.67%),其中广泛性11例(33.33%).MMF联合CsA和MTX方案与常规CsA联合MTX方案相比,前者可减少aGVHD发生率(P<0.05),虽两者cGVHD总发生率无差异(P>0.05),但前者广泛性cGVHD明显减少(P<0.05);本组患者中位随访30个月存活33例,移植后3年无病生存率为66%;GVHD合并感染和间质性肺炎是主要死因.结论:ABO血型不合不影响移植,但移植后血红蛋白恢复较慢;Allo-PBSCT中aGVHD发生率并不高,但cGVHD发生率明显升高;MMF联合CsA和MTX方案预防GVHD较常规CsA联合MTX方案为优.
目的:評價異基因外週血造血榦細胞移植(Allo-PBSCT)治療白血病的療效,同時比較ABO血型相閤與不相閤移植以及兩種移植物抗宿主病(GVHD)預防方案.方法:用Allo-PBSCT治療白血病50例(急性29例,慢性21例),其中ABO血型相閤30例,不相閤20例.PBSC動員採用G-CSF或G-CSF+GM-CSF皮下註射5 d;預處理採用CTX+VP16+TBI或CTX+TBI方案;GVHD預防採用常規環孢素A(CsA)+短程甲氨蝶呤(MTX)和黴酚痠酯(MMF)聯閤CsA+短程MTX兩種方案.結果:本組患者經Allo-PBSCT均穫得造血功能重建.ABO血型相閤移植與不相閤移植比較,後者血紅蛋白恢複較慢(P<0.05),中性粒細胞和血小闆恢複兩者無差異(P>0.05).本組髮生aGVHD 20例(40%),其中Ⅱ度以上9例(18%).生存6箇月以上者髮生cGVHD 22例(66.67%),其中廣汎性11例(33.33%).MMF聯閤CsA和MTX方案與常規CsA聯閤MTX方案相比,前者可減少aGVHD髮生率(P<0.05),雖兩者cGVHD總髮生率無差異(P>0.05),但前者廣汎性cGVHD明顯減少(P<0.05);本組患者中位隨訪30箇月存活33例,移植後3年無病生存率為66%;GVHD閤併感染和間質性肺炎是主要死因.結論:ABO血型不閤不影響移植,但移植後血紅蛋白恢複較慢;Allo-PBSCT中aGVHD髮生率併不高,但cGVHD髮生率明顯升高;MMF聯閤CsA和MTX方案預防GVHD較常規CsA聯閤MTX方案為優.
목적:평개이기인외주혈조혈간세포이식(Allo-PBSCT)치료백혈병적료효,동시비교ABO혈형상합여불상합이식이급량충이식물항숙주병(GVHD)예방방안.방법:용Allo-PBSCT치료백혈병50례(급성29례,만성21례),기중ABO혈형상합30례,불상합20례.PBSC동원채용G-CSF혹G-CSF+GM-CSF피하주사5 d;예처리채용CTX+VP16+TBI혹CTX+TBI방안;GVHD예방채용상규배포소A(CsA)+단정갑안접령(MTX)화매분산지(MMF)연합CsA+단정MTX량충방안.결과:본조환자경Allo-PBSCT균획득조혈공능중건.ABO혈형상합이식여불상합이식비교,후자혈홍단백회복교만(P<0.05),중성립세포화혈소판회복량자무차이(P>0.05).본조발생aGVHD 20례(40%),기중Ⅱ도이상9례(18%).생존6개월이상자발생cGVHD 22례(66.67%),기중엄범성11례(33.33%).MMF연합CsA화MTX방안여상규CsA연합MTX방안상비,전자가감소aGVHD발생솔(P<0.05),수량자cGVHD총발생솔무차이(P>0.05),단전자엄범성cGVHD명현감소(P<0.05);본조환자중위수방30개월존활33례,이식후3년무병생존솔위66%;GVHD합병감염화간질성폐염시주요사인.결론:ABO혈형불합불영향이식,단이식후혈홍단백회복교만;Allo-PBSCT중aGVHD발생솔병불고,단cGVHD발생솔명현승고;MMF연합CsA화MTX방안예방GVHD교상규CsA연합MTX방안위우.
Objective:To evaluate the efficacy of allogeneic peripheral blood stem cell transplantation (Allo-PBSCT) in the treatmemt of leukemia.Methods: Twenty-nine patients with acute leukemia and 21 patients with chronic leukemia were treated with Allo-PBSCT. ABO blood types were matched in 30 patients and mismatched in 20 patients. PBSC were mobilized with G-CSF or G-CSF+GM-CSF for 5 d. Conditioning regimens included standard TBI plus CTX or TBI plus CTX and VP16. Two regimens were used for prophylaxis of graft-versus-host disease (GVHD), one was the traditional combination of low dose cyclosporine(CsA) and short course methotrexate(MTX)(CsA/MTX group), the other was short course mycophenolate mofetil(MMF)besides CsA and MTX(MMF/CsA/MTX group). Results: All patients were successfully engrafted. Hemoglobin recovery (to 80 g/L) was significantly slower in ABO mismatched patients (median 52 d) than matched patients (median 14 d)(P<0.05), and there was no significant difference in the recovery of granulocyte and platelet (P>0.05). The incidence of aGVHD was 40% (20/50) with grade Ⅱ-Ⅳ 18%(9/50). cGVHD occurred in 22 of 33 patients (66.67%) lived longer than 6 months post-transplantation, and 11 of them were with extensive cGVHD (33.33%). The incidence of aGVHD in MMF/CsA/MTX group (16.67%) was significantly lower than that of CsA/MTX group (53.13%)(P<0.05). Although the incidence of cGVHD was the same in 2 groups (P>0.05), the incidence of extensive cGVHD was lower in MMF/CsA/MTX group (9.09%) than that of CsA/MTX group (45.45%) (P<0.05).The median follow-up period was 30 months. The 3 year disease-free-survival (DFS) was 66%. GVHD, infection and interstitial pneumonitis were the main causes of death. Conclusion: Allo-PBSCT is a safe and effective therapy for leukemia. The MMF/CsA/MTX regimen for prevention of aGVHD is more efficient than CsA/MTX.
