【摘要】 目的观察自体骨髓混合HLA半相合异基因骨髓移植治疗急性白血病的疗效及移植相关并发症。方法对7例急性白血病患者先实施经液体培养(与IL-2共孵育,1000U/ml骨髓血)和微波照射法体外净化的自体骨髓移植,2￣5d后输注一定量HLA半相合同胞兄妹的异基因骨髓。结果中性粒细胞和血小板恢复的平均时间为+27d和+29d,3例发生Ⅲ￣Ⅳ度急性移植物抗宿主病(aGVHD)并死亡,其中1例并发肝静脉闭塞症。另外4例发生Ⅱ度aGVHD,HLA基因检测和(或)性染色体分析均呈混合嵌合现象并持续半年左右,这4例长期无病存活时间分别117,106,101,85个月,5年无病生存4例。结论混合骨髓移植具有疗效好、复发率低、患者可获长期生存及相对安全可行等特点,但仍有必要进一步优化同/异基因骨髓细胞的比例及植入时机,并采取一定程度的移植物抗宿主病(GVHD)预防措施。更多还原

【Abstract】 Objective In the studies, we observed the clinical outcome and the treatment related complications in patients with acute leukemia undergoing autologous bone marrow mixed allogeneic HLA haploidentical marrow transplantation. Methods Seven cases with acute leukemia were treated by autologous marrow, which was purged in vitro by microwave hyperthermia (42℃ for 1 hour) following incubation for 56 hours with interleukin 2 (IL-2, 1 000 U/ml marrow blood), then reinfused with HLA haploidentecal marrow cells from their siblings. Results The neutrophil and platelet engrafted on day 27 and 29 respectively. Three cases died from grade Ⅲ～Ⅳ acute graft-versus-host disease (aGVHD) and one of them was complicated by hepatic veno-occlusive disease (VOD). The other four cases which developed grade Ⅱ aGVHD have been alive and disease-free for 117, 106, 101 and 85 months respectively. Mixed chimera in four cases valuable had been existed for half a year. Conclusion These results show that mixed transplantation is a secure, feasible and effective approach to treat patients with malignant tumors. But it is essential to optimize further the ratio of mixed allogeneic HLA haploidentical marrow and engraftment timing and to take some kind of GVHD prophylaxis.更多还原