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目的探讨不同预处理方案以及不同移植方法治疗恶性血液病、实体瘤的疗效,对其移植效果及移植风险进行评价。方法回顾分析非净化自体骨髓移植(auto-HSCT)31例,外周血干细胞加自体骨髓活化移植(PBSCT+ABM)26例,清髓性异基因骨髓移植(allo-HSCT)18例,非清髓性异基因骨髓/外周血移植(allo-NSCT)43例,脐带血干细胞移植(CBT)7例的临床资料。PBSCT+ABM、auto-HSCT和allo-HSCT均采用MAC方案预处理。PBSCT+ABM系采用自身外周血干细胞及体外活化自体骨髓液750ml回输;allo-HSCT采集供者骨髓液于移植0d回输;allo-NSCT是采用低强度的FAAC或MAAC两种方案预处理,移植后根据嵌合体形成的情况,以递增方式将供体淋巴细胞输注(DLI)给患者。allo-CBT患儿,2例采用脐血库的干细胞,HLA配型4个以上的位点相合,5例采用同胞的脐带血干细胞,预处理采用CTX/ATG,移植的程序与上述一致。异基因移植患者常规使用免疫抑制剂(环胞霉素、氨甲蝶呤/骁悉),并根据白细胞、血小板、骨髓恢复,ABO血型分析,STR测定嵌合体形成等情况作为植活的证据。aGVHD按Glucksberg标准分析,cGVHD根据Shul man标准分析。结果125例患者中除有1例慢性髓性白血病(CML)NSCT移植后40d时植入失败死于骨髓衰竭,1例急性髓性白血病(AML)NSCT在造血恢复前死于脑出血外,其余123例都预期恢复造血。异基因移植aGVHD发生率9.69%,cGVHD发生率22.23%。auto-HSCT31例,截止资料分析时生存8例(25.80%)。PBSCT+ABM26例,生存15例(57.69%),allo-HSCT18例,生存11例(61.11%),NSCT43例,生存19例(45%)。CBT7例生存2例。结论异基因造血干细胞移植是一种根治性的治疗手段,尤其非清髓性预处理的异基因造血干细胞移植方法不仅扩大了移植的应用范围及适应证,而且提高了移植的安全性并降低了移植费用。
Objective To investigate the curative effect of different preconditioning regimens and different transplantation methods on hematologic malignancies and solid tumors and evaluate the effect of transplantation and the transplantation risk. Methods Thirty-one cases of non-purifying autologous bone marrow transplantation (auto-HSCT), 26 cases of peripheral blood stem cells plus autologous bone marrow transplantation (PBSCT + ABM), 18 cases of myeloablative allogeneic bone marrow transplantation (allo-HSCT) 43 cases of allogeneic bone marrow / peripheral blood transplantation (allo-NSCT) and 7 cases of cord blood stem cell transplantation (CBT). PBSCT + ABM, auto-HSCT and allo-HSCT were pre-treated with MAC protocol. PBSCT + ABM was transfused with 750ml peripheral blood stem cells and activated autologous bone marrow fluid in vitro; allo-HSCT was collected and transfused 0d bone marrow fluid donor allo-NSCT was pretreated with low-intensity FAAC or MAAC, Following transplantation, donor lymphocytes are infused (DLI) to the patient in an incremental fashion, depending on the formation of the chimera. Allo-CBT children, 2 cases of umbilical cord blood stem cells, HLA matching more than 4 sites, 5 cases using sibling cord blood stem cells, pretreatment using CTX / ATG, transplantation procedures consistent with the above. Immunosuppressive agents (cyclosporine, methotrexate / xidoxi) were routinely used in patients with allogeneic transplantation and evidence of engraftment was based on leukocyte, platelet, bone marrow recovery, ABO blood group analysis, and STR determination of chimerism. aGVHD according to Glucksberg standard analysis, cGVHD Shul man standard analysis. Results One hundred and two patients died of bone marrow failure 40 days after transplantation of chronic myelogenous leukemia (CML). One case of acute myeloid leukemia (AML) NSCT died of intracerebral hemorrhage before hematopoietic recovery 123 cases are expected to restore hematopoiesis. Allogeneic transplantation aGVHD incidence of 9.69%, cGVHD incidence of 22.23%. auto-HSCT31 cases, up to the end of data analysis, 8 cases (25.80%). There were 26 cases of PBSCT + ABM, 15 cases of survival (57.69%), allo-HSCT of 18 cases, 11 cases of survival (61.11%), NSCT of 43 cases and 19 cases of survival (45%). Two cases of CBT7 survived. Conclusion Allogeneic hematopoietic stem cell transplantation is a radical treatment, especially non-myeloablative preconditioning allogeneic hematopoietic stem cell transplantation not only expands the scope and indications of transplantation, but also improves the safety of transplantation and reduces the Transplant costs.