CAJ | 학술논문

目的评价异基因外周血造血干细胞移植（allo-PBSCT）治疗急性单核细胞白血病（M5）的疗效，并探讨其并发症的预防及处理。方法16例M5患者接受allo-PBSCT，其中亲缘11例，非亲缘5例。预处理方案：9例采用清髓方案BUCY，7例采用非清髓方案FBC。亲缘的11例均采用环孢素＋短程甲氨蝶呤预防移植物抗宿主病（GVHD），非亲缘的5例均采用环孢素＋甲氨蝶呤＋吗替麦考酚酯＋ATG。输注的外周血干细胞有核细胞中位数为6.58×108/kg，CD34＋细胞中位数为4.46×106/kg。结果16例患者中15例均证实植活，余1例在移植早期因HVOD死亡。植入病人中白细胞植入中位时间为13（9～17）d，血小板＞20×109/L的中位时间为16（8～26）d。发生急性GVHD 6例（Ⅰ度4例，Ⅱ度2例），发生局限性慢性GVHD 7例。目前无病存活10例，中位生存期为45（3～78）个月。结论Allo-PBSCT是治疗M5的有效手段，并发症少，能有效延长患者生存时间。
목적평개이기인외주혈조혈간세포이식（allo-PBSCT）치료급성단핵세포백혈병（M5）적료효，병탐토기병발증적예방급처리。방법16례M5환자접수allo-PBSCT，기중친연11례，비친연5례。예처리방안：9례채용청수방안BUCY，7례채용비청수방안FBC。친연적11례균채용배포소＋단정갑안접령예방이식물항숙주병（GVHD），비친연적5례균채용배포소＋갑안접령＋마체맥고분지＋ATG。수주적외주혈간세포유핵세포중위수위6.58×108/kg，CD34＋세포중위수위4.46×106/kg。결과16례환자중15례균증실식활，여1례재이식조기인HVOD사망。식입병인중백세포식입중위시간위13（9～17）d，혈소판＞20×109/L적중위시간위16（8～26）d。발생급성GVHD 6례（Ⅰ도4례，Ⅱ도2례），발생국한성만성GVHD 7례。목전무병존활10례，중위생존기위45（3～78）개월。결론Allo-PBSCT시치료M5적유효수단，병발증소，능유효연장환자생존시간。
Objective To study the therapeutic effectiveness and associated complications of allogeneic pe -ripheral blood stem cells transplantation (Allo-PBSCT) in treatment of acute monocytic leukemia (M5 ).Methods Sixteen patients with acute monocytic leukemia received allo-PBSCT,11 patients received PBSCT from human leuco-cyte antigen(HLA)-matched sibling donors and 5 from HLA-matched unrelated donors.Pre-Processing regimen:9 patients were subjected to modified BU/CY2 regimen which was myeloablative , another 7 patients were subjected to FBC regimen which was non-myeloablative.The graft-versus-host disease(GVHD) was prevented by cyclosporin A (CsA),short-term methotrexate(MTX)in 11 patients who received PBSCT from HLA-matched sibling donors, and another 5 patients additionally received antithymocyte globulin (ATG) and mycophenolate mofetil (MMF).A median of 6.58 ×10 8/kg nucleated cells and 4.46 ×10 6/kg CD34+cells were transfused.Results Except for 1 patient died early after transplantation because of hepatic veno-occlusie disease(HVOD).Other 15 patients achieved engraftment confirmed by blood type, chromosome test and DNA polymorphism,with median times of neutrophil >0.5 ×10 9/L and platelet >20 ×10 9/L being 13(9~17)d and 16(8~26)d respectively.Six patients developed acute GVHD (4 developed gradeⅠand 2 developed gradeⅡ).Seven patients experienced local chronic GVHD .Ten patients were found to have disease-free survival(DFS), median of 45 (3~78)months.Conclusion Allo-PBSCT was an effective therapy for acute monocytic leukemia,it was safe and feasible,and long term survival was hoped for patients of this type.