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目的:异基因造血干细胞移植治疗急性淋巴细胞白血病的疗效已不容置疑,在不具备异基因造血干细胞移植条件下,评价自体造血干细胞移植治疗急性淋巴细胞白血病的疗效。方法:选取1989-05/2000-07解放军总医院血液科43例急性淋巴细胞白血病患者,所有患者均同意行自体造血干细胞移植。中位年龄24.5(11～48)岁。单次移植29例,其中移植前首次完全缓解期23例,二次缓解期5例,未缓解期1例。双次移植14例,其中首次移植和第二次移植前为二次缓解期各1例,其余移植前均为首次完全缓解期。预处理方案:包括含全身放疗(26例)、全淋巴放疗(14例)与不含全身放疗的高剂量化疗方案(3例)。移植后治疗:化疗长春新碱+泼尼松/6-巯基嘌呤+甲氨蝶呤方案和白细胞介素2免疫维持治疗。结果:单次自体造血干细胞移植29例5年无病存活10例,其中移植前首次完全缓解期9例,二次缓解期1例。5年无病存活率34.5%。双次移植14例5年无病存活6例,5年无病存活率为42.9%。两次移植前均为首次完全缓解期。结论:在不具备异基因造血干细胞移植条件下,可采用自体造血干细胞移植治疗急性淋巴细胞白血病,双次自体造血干细胞移植疗效较好。
OBJECTIVE: The efficacy of allogeneic hematopoietic stem cell transplantation in the treatment of acute lymphoblastic leukemia has been beyond doubt. To evaluate the efficacy of autologous hematopoietic stem cell transplantation in the treatment of acute lymphoblastic leukemia without allogeneic hematopoietic stem cell transplantation. Methods: A total of 43 acute lymphoblastic leukemia patients from Department of Hematology, People’s Liberation Army General Hospital were selected from May 1989 to July 2000, and all patients were given autologous hematopoietic stem cell transplantation. The median age of 24.5 (11 ~ 48) years old. A single transplantation in 29 cases, including the first complete remission before transplantation in 23 cases, 5 cases of secondary remission, non-remission in 1 case. Double transplantation in 14 cases, of which the first transplant and the second transplant before the second remission of 1 cases, the rest were the first complete remission before transplantation. Pretreatment regimens included systemic radiotherapy (n = 26), total lymphatic radiation (n = 14) and high-dose chemotherapy without systemic radiotherapy (n = 3). Post-transplant treatment: Chemotherapy vincristine + prednisone / 6-mercaptopurine + methotrexate regimen and interleukin 2 immuno-maintenance therapy. Results: There were 29 cases of single autologous hematopoietic stem cell transplantation in 5 years without disease survived in 10 cases, including the first complete remission 9 cases before transplantation and the second remission 1 case. Five years disease-free survival rate of 34.5%. There were 6 cases of 5-year disease-free survival in 14 cases after double transplantation, and the disease-free survival rate in 5 years was 42.9%. Before the two transplants are the first complete remission. CONCLUSION: Autologous hematopoietic stem cell transplantation can be used to treat acute lymphoblastic leukemia without allogeneic hematopoietic stem cell transplantation. Double autologous hematopoietic stem cell transplantation is effective.