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造血干细胞移植是治疗急性白血病(AL)的手段之一。对于高危ALL,如Ph+和T细胞型,第1次完全缓解(CR1)后行异基因造血干细胞移植(allo-HSCT)的整体生存率(OS)和无瘤生存率(DFS)优于化疗,对于CR2首选allo-HSCT,尤其对于早期复发者;对于CR3后采用allo-HSCT,通过诱导移植物抗白血病降低复发率。移植ALL采用含全身照射方案有优势。对于AMLCR1后allo-HSCT在OS和DFS优于化疗,AML第2次复发时,如获得供者,allo-HSCT治疗为首选,AML行移植后复发者,可行二次移植。移植AML采用含TBI方案无优势,采用G-CSF与大剂量阿糖胞苷方案,可提高DFS。非血缘脐血具有许多优点,在DFS和复发率与无关骨髓移植相当,是造血干细胞的一种来源。
Hematopoietic stem cell transplantation is one of the means of treating acute leukemia (AL). The overall survival (OS) and disease-free survival (DFS) of allo-HSCT after primary complete remission (CR1) were superior to those of chemotherapy for high-risk ALL, such as Ph + and T cell types, Allo-HSCT is preferred for CR2, especially for early relapse; allo-HSCT for CR3 is used to reduce the relapse rate by inducing graft-versus-leukemia. ALL transplantation with systemic irradiation programs have advantages. Allo-HSCT is better than chemotherapy for OS and DFS after AMLCR1. When the second relapse of AML is achieved, donor allo-HSCT is the first choice and all A-line relapse after transplantation is feasible. Transplantation of AML with TBI program has no advantage, using G-CSF and high-dose cytarabine program can improve DFS. Non-blood cord blood has many advantages, and the DFS and recurrence rates are comparable to unrelated bone marrow transplantation and are a source of hematopoietic stem cells.