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为了研究非清髓性异基因造血干细胞移植 (non myeloablativeallogeneicstemcelltransplantation ,allo NST)治疗恶性血液病的疗效及相关技术 ,对 2 6例恶性血液病患者 (急性白血病 10例 ,慢性髓性白血病 14例 ,多发性骨髓瘤 2例 )中 14例采用FAC预处理 (Fludara +ATG +CY) ,12例采用MAC预处理 (马法兰 /马利兰 +ATG +CY) ,用G CSF 6 0 0 μg/d或G CSF 30 0 μg/d +GM CSF 30 0 μg/d进行外周血干细胞动员 ,第 5天开始采用CobeSpectra血细胞分离机连续采集 2 - 3次 ;环孢菌素A联合短程甲氨蝶呤预防GVHD ;移植后第 4周开始供体淋巴细胞输注 ,首剂 1×10 7/kg ,之后依据临床反应及嵌合体形成情况 ,每 4周 1次 ,剂量逐级递增 ;以微卫星短串联重复序列 (STR)分析、Bcr/Abl融合基因、Ph染色体、HLA位点分析、性染色体及ABO血型等为植活检测指标。结果表明 ,植入率 84 .6 2 % ,其中 18例已转为完全供体型 ;aGVHD发生率 11.5 4 % ,cGVHD发生率 2 3 0 7% ;感染、出血等毒副反应发生率低、反应轻。结论 :非清髓性异基因造血干细胞移植治疗恶性血液病疗效确切 ,毒副作用小 ,但相关技术 ,如适应证的选择、预处理方案、移植过程中的免疫治疗等需要进一步深入研究。
In order to investigate the efficacy and related technologies of nonmyeloablative allogenic stem cell transplantation (allo NST) in the treatment of hematologic malignancies, we studied 26 patients with hematologic malignancies (10 acute leukemia, 14 chronic myelogenous leukemia, 14 cases were treated with FAC pretreatment (Fludara + ATG + CY), 12 cases were treated with MAC pretreatment (melphalan / maryland + ATG + CY), and treated with G CSF 60 000 μg / d or G CSF 30 0 μg / d + GM CSF 30 0 μg / d for mobilization of peripheral blood stem cells, continuous collection of Cobe Spectra cells for 2 to 3 times on day 5, cyclosporin A combined with short-range methotrexate for prevention of GVHD, The donor lymphocytes were infused at 4 weeks after the first dose of 1 × 10 7 / kg. After that, according to the clinical response and chimerism formation, the dosage was increased gradually every 4 weeks. The microsatellite short tandem repeat (STR ) Analysis, Bcr / Abl fusion gene, Ph chromosome, HLA loci analysis, sex chromosomes and ABO blood group as indicators of plant survival. The results showed that the implantation rate was 84.62%, of which 18 had been completely donor type; aGVHD incidence of 11.5 4%, cGVHD incidence of 2307%; infection, bleeding and other toxic reactions were low, the reaction rate light. CONCLUSION: Non-myeloablative allogeneic hematopoietic stem cell transplantation is effective in treating hematologic malignancies and has few toxic and side effects. However, related technologies such as indications, pretreatment protocols and immunotherapy in transplantation need further study.