中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (14): 2638-2642.doi: 10.3969/j.issn.1673-8225.2010.14.036

• 干细胞临床实践 clinical practice of stem cells • 上一篇    下一篇

改良BU/CY预处理方案在外周血造血干细胞移植中的临床应用

陈晓霞，王智明，罗贤生，徐丹丹，李  兴，雷美清   

  1. 中南大学湘雅医学院附属海口市人民医院血液科，海南省海口市  570208
  • 出版日期:2010-04-02 发布日期:2010-04-02
  • 作者简介: 陈晓霞，女，1962年生，江西省武宁县人，汉族，1985年江西医学院毕业，副主任医师，主要从事血液病及造血干细胞移植方面的研究。 chenxia_62@yahoo.com.cn
  • 基金资助:

    2005年海南省自然科学基金项目(80571)，课题名称“健康供者外周血造血干细胞动员及采集时机的探讨”。

Clinical application of modified BU/CY pretreatment scheme to peripheral blood hematopoietic stem cell transplantation

Chen Xiao-xia, Wang Zhi-ming, Luo Xian-sheng, Xu Dan-dan, Li Xing, Lei Mei-qing   

  1. Department of Hematology, Haikou Municipal People’s Hospital Affiliated to Xiangya School of Medicine, Central South University, Haikou  570208, Hainan Province, China
  • Online:2010-04-02 Published:2010-04-02
  • About author:Chen Xiao-xia, Associate chief physician, Department of Hematology, Haikou Municipal People’s Hospital Affiliated to Xiangya School of Medicine, Central South University, Haikou 570208, Hainan Province, China chenxia_62@yahoo.com.cn
  • Supported by:

    the Natural Science Foundation of Hainan Province in 2005, No. 80571*

PDF

469

被引次数

7

摘要：

背景：在异基因造血干细胞移植中，预处理方案的选择是造血干细胞移植成败的重要关键环节之一，也是干细胞移植的重要研究方向。清髓性预处理方案毒性大，预处理相关死亡率高，从而探索理想的预处理方案，期望在降低不良反应的同时减少复发。
目的：观察用改良Bu/CY预处理方案治疗恶性血液病的疗效。
方法：选取2003-11/2008-03在中南大学湘雅医学院附属海口市人民医院血液科住院患者8例，均采用改良的Bu/CY预处理方案：阿糖胞苷2.0~3.0 g/(m2•d)×2 d，持续24 h静滴；马利兰4 mg/(kg•d)×3 d；环磷酰胺50 mg/(kg•d)× 2 d；甲基环已亚硝脲25 mg/(m2•d)×1 d；抗胸腺细胞球蛋白25 mg/(kg•d)×4 d。在改良方案的基础上加大阿糖胞苷剂量1倍，且改为持续24 h静滴，使预处理强度增加，促进造血干细胞持久植入。移植物抗宿主病预防：在经典的甲氨蝶呤方案基础上将环孢素A及霉酚酸酯提前至-7 d(回输干细胞前为-)使用。患者移植前后进行ABO血型及DNA检测。
结果与结论： ①移植后造血重建检测：8例患者均获得造血重建，未发生预处理相关死亡。造血于细胞移植后-3~+7 d白细胞降为0，并持续3~22 d，+10~+21 d白细胞>1.0×109 L-1，+11~+51 d血小板>20×109 L-1。②移植物抗宿主病的发病情况：8例患者移植物抗宿主病Ⅳ级(肠道)1例，急性移植物抗宿主病Ⅰ~Ⅱ级3例。提示进一步改良BU/CTX方案其不良反应小，优于经典的全身照射/CY方案，且简便易行，抗白血病作用确实可靠，是治疗恶性血液病安全有效的方法。

关键词: 造血干细胞移植, 移植预处理, 白血病, 淋巴瘤, 移植物抗宿主病

Abstract:

BACKGROUND: In allogene hematopoietic stem cell transplantation, the choice of preconditioning scheme is an important link of the success of hematopoietic stem cell transplantation, and a major research direction of stem cell transplantation. The myeloablative pretreatment scheme has great toxicity, and pretreatment related death rate is high. Thus, it is necessary to explore an ideal pretreatment scheme to expect a decrease in side effects and relapse.
OBJECTIVE: To observe the effect of modified Bu/CY pretreatment regimen for treating hematologic malignancies.
METHODS: The 8 patients were selected at the Department of Hematology, Haikou Municipal People’s Hospital Affiliated to Xiangya School of Medicine, Central South University from November 2003 to March 2008, and received modified Bu/CY pretreatment: cytarabine 2.0-3.0 g/(m2•d)× 2 d, intravenous drip, for 24 consecutive hours; myleran 4 mg/(kg•d)× 3 d; cyclophosphamide 50 mg/(kg•d)× 2 d; methyl-cyclohexyl nitrosourea 25 mg/(m2•d)×1 d; antithymocyte globulin 25 mg/(kg•d)× 4 d. We have increased the arabinosylcytosin dose twice, and changed to a 24-hour infusion via intravenous drip, so that pretreatment strength was increased and promote lasting implantation of hematopoietic stem cells, based on the modified program. Graft-versus-host disease (GVHD) prevention: cyclosporin A and mycophenolate mofetil would be used advanced to minus 7 days (one day before stem cell transfusion is minus 1) based on the classic methotrexate regimen. The ABO blood group changes and DNA were tested in patients before and after transplantation.
RESULTS AND CONCLUSION:  ①The detection of hematopoietic reconstitution after transplantation: All patients have received hematopoietic reconstitution, with no pretreatment-related death. The white blood cells reduced to 0 after -3 - +7 days of hematopoietic stem cell transplantation, and continues to (3-22) days, +10 - +21 days white blood cells > 1.0×109 /L, +11 - +51 days, platelets > 20×109 /L. ②Incidence of GVHD: of 8 patients, there were GVHD Ⅳ grade (intestinal) in 1 case, acute graft-versus-host disease grade Ⅰ-Ⅱ in 3 cases. Above-mentioned results indicated that the further modification of BU/CTX2 regimen may be an effective pretreatment program, with a few side effects, which is better than the classic total-body irradiation/CY regimen. What’s more, it is simple accurate, reliable role of anti-leukemia and will be a safe and effective method for treating hematologic malignancies.

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