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目的 总结 84例异基因造血干细胞移植 (包括 :同胞异基因造血干细胞移植、无血缘关系异基因造血干细胞移植和脐血干细胞移植 )治疗白血病的疗效和生存状况。方法 预处理方案CML采用标准BuCy方案 (马利兰 4mg/kg·d× 4,环磷酰胺 60mg/kg·d× 2 ) ;ALL采用E TBICy方案 (VP 165 0mg/kg× 1,TBI10 0 0～ 110 0cGy ,分 3次完成 ,CTX60mg/kg·d× 2 ) ;AML采用BuACy方案 (马利兰 4mg/kg·d× 2 ,Ara c3 .0g/m2 ·d× 2 ,CTX60mg/kg·d× 2 )。移植物抗宿主病的预防采用CsA +MTX +IVIg方案。结果 84例中 47例仍然无病存活 ( 5 4 7% )。移植后 10 0天存活 64人 ( 75 2 % ) ;10 0天内死亡原因分别为 :急性GVHD ,MOF ,CMV间质性肺炎 ,播散性感染 ,早期复发 ,和植入失败 ;移植后 10 0天～ 2年内死亡 16例 ,死亡原因分别为疾病复发、CMV感染和慢性GVHD ,移植后存活超过 2年者中无死亡病例 ,最长生存已 9年。CML61例目前仍无病存活 3 7例 ( 60 6% ) ,AML15例仍无病存活 7例 ( 4 6 6% ) ,ALL8例仍无病存活 3例 ( 3 8% )。结论 异基因造血干细胞移植可使相当部分白血病患者获得长期无病存活 ,其中部分患者获得治愈。本组患者移植后 10 0天内死亡原因主要是急性GVHD ;移植后 10 0天～ 2年内死亡的主要原因是疾?
Objective To summarize the curative effect and survival of 84 allogeneic hematopoietic stem cell transplantation (including allogeneic hematopoietic stem cell transplantation, unrelated allogeneic hematopoietic stem cell transplantation and umbilical cord blood stem cell transplantation) in the treatment of leukemia. Methods CML was treated with standard BuCy regimen (4mg / kg · d × 4, cyclophosphamide 60mg / kg · d × 2). ALL patients were treated with E TBICy regimen (VP 165 0mg / kg × 1, TBI10 0 ~ 110 0cGy in 3 replicates, CTX 60mg / kg · d × 2). The AML used BuACy regimen (4mg / kg · d × 2, Ara c3.0g / m2 · d × 2, CTX60mg / kg · d × 2). Prevention of graft-versus-host disease using CsA + MTX + IVIg program. Results Of the 84 cases, 47 remained disease-free (54.7%). Sixty-four survivors (75 2%) survived 10 days after transplantation. The causes of death within 10 days were: acute GVHD, MOF, CMV interstitial pneumonia, disseminated infection, early recurrence, and failed implantation; There were 16 deaths within ~ 2 years. The causes of death were disease recurrence, CMV infection and chronic GVHD. No deaths occurred after more than 2 years after transplantation. The longest survival was 9 years. There are still 31 cases (60.6%) of patients with CML without disease, 15 cases without disease survived in 7 cases (46.6%) with AML, and 3 cases (38%) with ALL without disease. Conclusion Allogeneic hematopoietic stem cell transplantation can make a considerable part of leukemia patients get long-term disease-free survival, in which some patients were cured. This group of patients died within 10 days after transplantation is mainly due to acute GVHD; death after 10 0 days to 2 years the main reason for death is disease?