论文部分内容阅读
骨髓增生异常综合征转为红白血病的患者属高危白血病,常规化疗达到完全缓解的机率低且短期内复发率高,患者经包括氟达拉滨、去甲氧柔红霉素在内的多个方案化疗均无法完全缓解,所以尝试用造血干细胞移植治疗。受者为未缓解、合并溶血病例,且无人类白细胞抗原配型相合的血缘供者,如予Bu-CTX2方案预处理,单用环孢素A+甲氨蝶呤方案预防移植物抗宿主病,则面临并发症多、移植成功率低或移植后易复发等难题。因此采用了阿糖胞苷、马利兰、环磷酰胺、甲基环己亚硝脲及抗人淋巴细胞免疫球蛋白联合使用作为预处理方案,在环孢素A和短程甲氨蝶呤的基础上加小剂量霉酚酸酯预防急性移植物抗宿主病;虽然并发肝静脉闭塞病、Ⅱ度肠型急性移植物抗宿主病及迟发性出血性膀胱炎,但程度较轻,经予前列地尔、甲基强的松龙、碱化、水化尿液等措施后病情很快得到控制;移植后52d染色体核型分析转为供者型,移植后36个月随访受者仍无病存活,复查外周血像、骨髓像均正常。故对于未缓解急性白血病,采用改良Bu-CTX2预处理方案行异基因造血干细胞移植是有效的救治方法之一。
Myelodysplastic syndrome into leukemia in patients with high-risk leukemia, conventional chemotherapy to achieve complete remission and the low probability of recurrence in the short term high rate of patients, including fludarabine, daunorubicin, including multiple Program chemotherapy are not completely relieved, so try to use hematopoietic stem cell transplantation. The recipients were unrefused and hemolytic cases without blood leukocyte antigen matching donor, such as Bu-CTX2 program pretreatment, cyclosporine A + methotrexate alone with the program to prevent graft-versus-host disease, Then face more complications, low success rate of transplantation or easy to relapse after transplantation and other problems. Therefore, the use of cytarabine, Maryland, cyclophosphamide, methylcyclohexylnitrosamide and anti-human lymphocyte immunoglobulin combined use as a pre-treatment program, based on cyclosporine A and short-range methotrexate Plus a small dose of mycophenolate to prevent acute graft-versus-host disease; although concurrent hepatic veno-occlusive disease, Ⅱ degree intestinal acute graft-versus-host disease and delayed hemorrhagic cystitis, but to a lesser extent, by the forefront The symptoms were quickly controlled by measures of methylprednisolone, alkalization, and hydration of urine. The chromosome karyotype analysis on day 52 was transplanted to donor type. After 36 months of transplantation, the recipients were still alive without disease , Review of peripheral blood, bone marrow were normal. Therefore, for the treatment of acute leukemia, allogeneic hematopoietic stem cell transplantation using modified Bu-CTX2 pretreatment is an effective treatment.