發(fā)布時(shí)間：2018-05-12 13:47

  本文選題：異基因造血干細(xì)胞移植 + 急性淋巴細(xì)胞白血病��； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的對(duì)急性淋巴細(xì)胞白血病(ALL)患者行異基因造血干細(xì)胞移植(allo-HSCT)的治療效果進(jìn)行回顧性總結(jié)分析。方法查詢整理2009年3月~2016年12月共32例ALL患者于我院行allo-HSCT,其中費(fèi)城染色體陽(yáng)性(Ph+)ALL 8例,Ph-ALL 24例;移植前達(dá)到第一次完全緩解(CR1)26例,第二次完全緩解(CR2)3例,第二次復(fù)發(fā)部分緩解(PR)2例,未緩解(UR)1例。同胞全相合、無(wú)關(guān)供者全相合和親緣單倍體分別為9例、5例和18例;2例行骨髓移植(BMT)聯(lián)合外周血干細(xì)胞移植(PBSCT),30例PBSCT。預(yù)處理方案:以白消安/環(huán)磷酰胺(Bu/Cy)為主的23例,全身照射(TBI)/Cy為主的8例,氟達(dá)拉濱(Flu)/Bu者1例。常規(guī)采用環(huán)孢菌素A(Cs A)、嗎替麥考酚酯(MMF)、短程甲氨蝶呤(MTX)±兔抗人胸腺細(xì)胞免疫球蛋白(ATG)預(yù)防急性移植物抗宿主病(a GVHD)。結(jié)果32例患者移植后造血均成功重建,平均隨訪時(shí)間18.5月。隨訪結(jié)束有21例無(wú)病生存2~55月,1例移植后復(fù)發(fā)2次,給予CAR-T治療后仍無(wú)效,最終死亡;總生存率為65.6%;有11例(34.4%)因a GVHD、感染、移植相關(guān)的血栓性微血管病(TA-TMA)等移植相關(guān)并發(fā)癥及疾病復(fù)發(fā)死亡;非復(fù)發(fā)病死率為18.8%。結(jié)論allo-HSCT是治療ALL的有效手段,但如何避免移植后復(fù)發(fā)及致死性并發(fā)癥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) 鹵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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R733.71

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本文編號(hào)：1878848