單份非血緣臍血移植治療伴中樞神經(jīng)系統(tǒng)白血病的急性白血病15例療效觀(guān)察
發(fā)布時(shí)間：2018-07-14 16:27
【摘要】：目的探討強(qiáng)化清髓不含胸腺細(xì)胞免疫球蛋白的單份非血緣臍血移植治療伴中樞神經(jīng)系統(tǒng)白血病(central nervous system leukemia,CNSL)的急性白血病療效。方法回顧性分析2009年7月至2014年9月在我科接受該治療的15例急性白血病患者臨床特征,其中急性單核細(xì)胞白血病2例,急性未分化型白血病1例,急性淋巴細(xì)胞白血病12例。所有患者既往化療過(guò)程中存在CNSL,經(jīng)治療后移植前CNSL均達(dá)完全緩解。全部采用強(qiáng)化清髓預(yù)處理方案,其中全身照射/Ara-C/CY方案9例,Ara-c/Bu/CY方案3例,Flu/Bu/CY方案3例,預(yù)防移植物抗宿主病(graft-versus-host disease,GVHD)方案為環(huán)孢素聯(lián)合短程霉酚酸酯。結(jié)果 14/15例(93.3%)患者獲得造血重建,中性粒細(xì)胞、血小板植入的中位時(shí)間分別為19(13~27)d和41(20~85)d。移植相關(guān)并發(fā)癥:80%(12/15)患者出現(xiàn)植入前綜合征;14例可評(píng)估的患者中,3例患者出現(xiàn)Ⅱ~Ⅳ度急性GVHD,累積發(fā)生率為20.00%,1例患者出現(xiàn)Ⅲ~Ⅳ度急性GVHD,累積發(fā)生率為13.33%;3例患者出現(xiàn)局限型皮膚慢性GVHD,移植后720 d累積發(fā)生率為20.00%,無(wú)廣泛型慢性GVHD的發(fā)生。所有患者中位隨訪(fǎng)時(shí)間43.2(14.1~76.5)個(gè)月,因植入前多臟器功能衰竭死亡1例,重度急性GVHD死亡1例及原發(fā)病復(fù)發(fā)死亡2例;復(fù)發(fā)3例,其中2例骨髓復(fù)發(fā),僅1例CNSL復(fù)發(fā),經(jīng)鞘內(nèi)注射及頭顱放療,腦脊液恢復(fù)正常。3年預(yù)計(jì)總生存率及無(wú)白血病生存率分別為60.0%和53.3%。結(jié)論強(qiáng)化清髓不含胸腺細(xì)胞免疫球蛋白的單份非血緣臍血移植治療伴CNSL的急性白血病初步結(jié)果顯示療效較好,值得推廣應(yīng)用。
[Abstract]:Objective to investigate the therapeutic effect of single non-blood cord blood transplantation without thymocyte immunoglobulin in the treatment of acute leukemia with central nervous system leukemia (central nervous system). Methods the clinical features of 15 patients with acute leukemia received in our department from July 2009 to September 2014 were analyzed retrospectively, including 2 cases of acute monocytic leukemia, 1 case of acute undifferentiated leukemia and 12 cases of acute lymphoblastic leukemia. CNSL was present in all patients during previous chemotherapy, and CNSL was completely relieved before transplantation. All of them were treated with enhanced myeloablative preconditioning regimen. 9 cases of whole body irradiation / Ara-C- / CY regimen were treated with Ara-c / Bu / CY regimen and 3 cases were treated with Flu-C / B / CY regimen. The regimen of preventing graft-versus-host disease was cyclosporine combined with mycophenolate mofetil. Results the median time of hematopoietic reconstitution, neutrophils and platelets implantation was 19 (1327) d and 41 (20 / 85) d in 14 / 15 (93.3%) patients, respectively. Transplantation-related complications: 80% (12 / 15) of 14 patients with pre-implantation syndrome and 3 of 14 patients with grade 鈪，
本文編號(hào)：2122237
[Abstract]:Objective to investigate the therapeutic effect of single non-blood cord blood transplantation without thymocyte immunoglobulin in the treatment of acute leukemia with central nervous system leukemia (central nervous system). Methods the clinical features of 15 patients with acute leukemia received in our department from July 2009 to September 2014 were analyzed retrospectively, including 2 cases of acute monocytic leukemia, 1 case of acute undifferentiated leukemia and 12 cases of acute lymphoblastic leukemia. CNSL was present in all patients during previous chemotherapy, and CNSL was completely relieved before transplantation. All of them were treated with enhanced myeloablative preconditioning regimen. 9 cases of whole body irradiation / Ara-C- / CY regimen were treated with Ara-c / Bu / CY regimen and 3 cases were treated with Flu-C / B / CY regimen. The regimen of preventing graft-versus-host disease was cyclosporine combined with mycophenolate mofetil. Results the median time of hematopoietic reconstitution, neutrophils and platelets implantation was 19 (1327) d and 41 (20 / 85) d in 14 / 15 (93.3%) patients, respectively. Transplantation-related complications: 80% (12 / 15) of 14 patients with pre-implantation syndrome and 3 of 14 patients with grade 鈪，
本文編號(hào)：2122237
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