异基因造血干细胞移植治疗急性淋巴细胞白血病32例的临床分析

发布时间：2018-05-12 13:47

本文选题：异基因造血干细胞移植 + 急性淋巴细胞白血病　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的对急性淋巴细胞白血病(ALL)患者行异基因造血干细胞移植(allo-HSCT)的治疗效果进行回顾性总结分析。方法查询整理2009年3月~2016年12月共32例ALL患者于我院行allo-HSCT,其中费城染色体阳性(Ph+)ALL 8例,Ph-ALL 24例;移植前达到第一次完全缓解(CR1)26例,第二次完全缓解(CR2)3例,第二次复发部分缓解(PR)2例,未缓解(UR)1例。同胞全相合、无关供者全相合和亲缘单倍体分别为9例、5例和18例;2例行骨髓移植(BMT)联合外周血干细胞移植(PBSCT),30例PBSCT。预处理方案:以白消安/环磷酰胺(Bu/Cy)为主的23例,全身照射(TBI)/Cy为主的8例,氟达拉滨(Flu)/Bu者1例。常规采用环孢菌素A(Cs A)、吗替麦考酚酯(MMF)、短程甲氨蝶呤(MTX)±兔抗人胸腺细胞免疫球蛋白(ATG)预防急性移植物抗宿主病(a GVHD)。结果32例患者移植后造血均成功重建,平均随访时间18.5月。随访结束有21例无病生存2~55月,1例移植后复发2次,给予CAR-T治疗后仍无效,最终死亡;总生存率为65.6%;有11例(34.4%)因a GVHD、感染、移植相关的血栓性微血管病(TA-TMA)等移植相关并发症及疾病复发死亡;非复发病死率为18.8%。结论allo-HSCT是治疗ALL的有效手段,但如何避免移植后复发及致死性并发症的方案仍需深入研究。
[Abstract]:Objective to review the therapeutic effect of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with acute lymphoblastic leukemia (ALL). Methods A total of 32 patients with ALL received allo-HSCT in our hospital from March 2009 to December 2016, including 8 cases of Ph-all with positive Ph all from Philadelphia, 26 cases of first complete remission before transplantation, 3 cases of second complete remission. There were 2 cases of partial remission and 1 case of non-remission. Sibling heterogeneity, unrelated donor homozygous and homologous haploid were 9 / 5 and 18 / 2, respectively, combined with peripheral blood stem cell transplantation (PBSCT) and peripheral blood stem cell transplantation (PBSCT) in 30 cases of PBSCT. Pretreatment: 23 cases were pretreated with Baoxuan / cyclophosphamide Bu-Cyy, 8 cases with TBI / Cy, and 1 case with Fluoradine / Bu. Cyclosporine (A(Cs), mycophenolate mofetil (MMF), short course methotrexate (MTX) 卤rabbit anti-human thymocyte immunoglobulin (ATG) were used to prevent acute graft-versus-host disease. Results Hematopoietic reconstruction was successfully performed in 32 patients after transplantation, with an average follow-up time of 18.5 months. At the end of follow up, 21 cases survived 2 ~ 55 months without disease and 1 case recurred 2 times after transplantation, but still failed after CAR-T treatment, and finally died. The overall survival rate was 65. 6% and 11 cases with 34. 4% of the patients were infected with a GV HD. Transplantation-related thrombotic microvascular disease (TA-TMA) and other transplant related complications and disease recurrence mortality was 18.8%. Conclusion allo-HSCT is an effective method for the treatment of ALL, but how to avoid recurrence and fatal complications after transplantation still needs further study.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733.71

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