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目的探讨采用全身照射(TBI)预处理方案行人类白细胞抗原(HLA)配型不相合亲缘供者非去T异基因造血干细胞移植(allo-HSCT)治疗白血病的疗效。方法2002年4月至2007年1月北京大学血液病研究所8例采用TBI预处理方案行HLA不合非去T亲缘供者allo-HSCT的白血病患者,其中急性髓性白血病(AML)3例,急性淋巴细胞性白血病(ALL)4例,慢性粒细胞白血病1例;预处理方案采用TBI加环磷酰胺(CY)方案4例,TBI加氟达拉滨(FLU)方案4例;干细胞来源包括骨髓和外周血造血干细胞移植6例,外周血造血干细胞移植(PBSCT)2例;移植物抗宿主病(GVHD)预防采用经典的环孢素A(CsA)+霉酚酸酯(MMF)+短程甲氨蝶呤(MTX)方案。结果8例供者采集单个核细胞(MNC)中位数为7.39(6.27~12.46)×108/kg,粒细胞植入中位时间11(11~13)d,血小板植入中位时间13(11~21)d。5例发生Ⅰ~Ⅱ度急性GVHD,2例出现慢性广泛性GVHD,无严重急性GVHD或因GVHD死亡病例。中位随访时间9(3~53)个月,除1例复发存活外,其余病例无病存活。结论对于HLA不相合异基因造血干细胞移植,TBI方案是一种比较安全、有效的非去T预处理方案,对于高危和二次移植患者同样有效。
Objective To investigate the curative effect of allo-HSCT in the treatment of leukemia with HLA-matched non-matched relatives (TBI) preconditioning with whole body irradiation. Methods From April 2002 to January 2007, 8 patients with leukemia who underwent TBI pretreatment and HLA-A to T unrelated donor allo-HSCT were enrolled in this study. Eight patients with acute myeloid leukemia (AML) 4 cases of acute lymphoblastic leukemia (ALL) and 1 case of chronic myelogenous leukemia. The pretreatment regimen used TBI plus cyclophosphamide (CY) regimen in 4 cases and TBI plus fludarabine (FLU) regimen in 4 cases. The stem cell sources included Bone marrow and peripheral blood hematopoietic stem cell transplantation in 6 cases, peripheral blood stem cell transplantation (PBSCT) in 2 cases; graft versus host disease (GVHD) prevention using classical cyclosporine A (CsA) + mycophenolate mofetil (MMF) Methotrexate (MTX) protocol. Results The median number of mononuclear cells (MNC) collected from 8 donors was 7.39 (6.27 ~ 12.46) × 108 / kg, the median of granulocyte transplantation was 11 (11 ~ 13) days and the median of platelet transplants was 13 11 ~ 21) d. 5 cases of acute GVHD Ⅰ ~ Ⅱ degree, 2 cases of chronic extensive GVHD, no serious acute GVHD or died of GVHD cases. The median follow-up time was 9 (3 ~ 53) months, except for 1 case of recurrence survivors, the remaining cases of disease-free survival. Conclusion The TBI regimen is a safe and effective non-T-pretreatment regimen for HLA-mismatched allogeneic hematopoietic stem cell transplantation and is equally effective in high-risk and secondary transplant patients.