CAJ | 학술논문

目的探讨单倍型异基因造血干细胞移植(allo-HSCT)治疗儿童复发难治性急性淋巴细胞白血病(ALL)的疗效和安全性.方法选择北京军区总医院血液科2010年1月至2013年1月采用allo-HSCT治疗的儿童复发难治性ALL患者20例,其中男12例,女8例,中位年龄9岁(1～ 14岁);B-ALL 14例,T-ALL 6例;移植时复发未缓解10例,复发后取得2次或者3次缓解10例;6例采用骨髓加外周血干细胞联合移植,14例仅采用外周血干细胞移植;预处理方案主要为白消安、氟达拉滨、环磷酰胺、抗胸腺细胞免疫球蛋白,部分患儿加用阿糖胞苷、依托泊苷或司莫司汀及接受全身照射等.移植物抗宿主病(GVHD)的预防采用环孢素、吗替麦考酚酯、甲氨蝶呤(+1、+3、+6、+11天).移植后观察患儿不良反应、并发症和无病生存等情况.结果全部患儿均获重建造血,移植后1个月供者细胞嵌合率均为100％.移植后粒细胞植活中位时间为12.5d(9～23d),血小板植活中位时间为15d(12～40d).随访至2014年6月,中位随访时间25个月(2 ～ 50个月),8例发生急性GVHD,11例发生慢性GVHD,因GVHD死亡2例,感染死亡1例,复发死亡2例,共死亡5例,其余15例患儿生存,全组患者的总体生存率为75％.结论单倍型allo-HSCT治疗儿童复发难治性ALL安全可行,长期生存率提高,移植后并发症及复发率并未增加.
목적 탐토단배형이기인조혈간세포이식(allo-HSCT)치료인동복발난치성급성림파세포백혈병(ALL)적료효화안전성.방법 선택북경군구총의원혈액과2010년1월지2013년1월채용allo-HSCT치료적인동복발난치성ALL환자20례,기중남12례,녀8례,중위년령9세(1～ 14세);B-ALL 14례,T-ALL 6례;이식시복발미완해10례,복발후취득2차혹자3차완해10례;6례채용골수가외주혈간세포연합이식,14례부채용외주혈간세포이식;예처리방안주요위백소안、불체랍빈、배린선알、항흉선세포면역구단백,부분환인가용아당포감、의탁박감혹사막사정급접수전신조사등.이식물항숙주병(GVHD)적예방채용배포소、마체맥고분지、갑안접령(+1、+3、+6、+11천).이식후관찰환인불량반응、병발증화무병생존등정황.결과 전부환인균획중건조혈,이식후1개월공자세포감합솔균위100％.이식후립세포식활중위시간위12.5d(9～23d),혈소판식활중위시간위15d(12～40d).수방지2014년6월,중위수방시간25개월(2 ～ 50개월),8례발생급성GVHD,11례발생만성GVHD,인GVHD사망2례,감염사망1례,복발사망2례,공사망5례,기여15례환인생존,전조환자적총체생존솔위75％.결론 단배형allo-HSCT치료인동복발난치성ALL안전가행,장기생존솔제고,이식후병발증급복발솔병미증가.
Objective To explore efficacy and safety of haploid allogeneic hematopoietic stem cell transplantation (allo-HSCT) for the children with relapsed or refractory acute lymphoblastic leukemia.Methods 20 cases of childhood acute lymphoblastic leukemia treated with haploid allo-HSCT were collected in Beijing Military General Hospital Hematology from Jan 2010 to Jan 2013,including 12 males and 8 females,with median age 9 (1-14) years old.There were 14 cases of B-ALL and 6 cases of T-ALL.When transplation,10 cases were relapsed without remission,and 10 cases were relapsed after 2 or 3 times to obtain remission.6 cases received bone marrow plus peripheral blood stem cell transplantation,and 14 cases received peripheral blood stem cell transplantation.Pretreatment program mainly were busulfan (Bu),fludarabine (Flu),cyclophosphamide (CTX) and anti-thymocyte immunoglobulin (ATG),plus cytarabine,etoposide or semustine and total body irradiation in some patients.Graft-versus-host disease (GVHD) was prevented by cyclosporine (CsA),mycophenolate mofetil (MMF) and methotrexate (MTX) (+1,+3,+6,+11 day).After transplantation,adverse reactions,complications and disease-free survival were observed.Results The hematopoiesis in all of children were rebuilded,and 1 month after transplantation,donor cells chimeric rate was 100 ％.After transplantation,the median time of granulocyte plant alive was 12.5 d (9-23 d),and that of platelet plant alive was 15 d (12-40 d).Follow-up until Jun 2014,the median follow-up time was 25 months (2-50 months) with 8 cases of acute GVHD,11 cases of chronic GVHD,and 5 cases of death including GVHD in 2 cases,infection in 1 case and recurrence in 2 cases.The overall survival rate was 75 ％ (15/20).Conclusion Haploid allo-HSCT for children with recurrent refractory lymphocytic leukemia scheme is safe,which could improve the long-term survival rate without increasing the complications and recurrence rate after transplantation.