Wu Bing-yi, Guo Kun-yuan, Song Chao-yang, Wu Lan-xiao, Yang Yu-lian, Li Yu-hua, Xiao Lu-lu
Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China.
Zhonghua Nei Ke Za Zhi. 2006 Feb;45(2):130-2.
To assess the outcomes of the therapy for patients with refractory leukemia with HLA haploidentical stem cells transplantation.
To analyze the outcomes of 30 patients with refractory leukemia who underwent HLA haploidentical peripheral blood stem cells transplantation from August 1998 to August 2004.
Thirty refractory leukemia patients including 13 cases of acute non-lymphocytic leukemia, 10 cases of acute lymphocytic leukemia (ALL), 6 cases of chronic myeloid leukemia and 1 case of phase IV non-Hodgkin's lymphoma underwent HLA haploidentical peripheral blood stem cells transplantation. The median age was 25 years old (3-52 years old). Twelve patients received stem cells from parent donors, four from daughter or son donors and the remaining from sibling donors. Three HLA loci mismatched in twelve cases, two HLA loci mismatched in thirteen cases and one HLA locus mismatched in five cases. The conditioning regime consisted of fludara (25 mg/m(2) x 5 d), busulfan (4 mg/kg x 4 d) and cyclophosphamide (60 mg/kg x 2 d). Rabbit anti-human lymphocyte globulin (5 mg/kg x 5 d) was added in some patients in the conditioning regime. A mean of 5.0 (2.9-8.0) x 10(8)/kg mononucleated cells was grafted. The number of mean CD(34)(+) cells was 5.5 (3.0-6.5) x 10(6)/kg. Twenty-seven patients were successfully grafted, one failed to graft, one died from severe fungal infection at day 2 and one died from severe veno-occlusive disease at day 28. The mean time of white cell count more than 1.0 x 10(9)/L was 14 (11-18) days and platelet count more than 20 x 10(9)/L was 15 (11-18) days. ALL the 27 successfully grafted patients got complete remission. Severe acute graft versus host disease occurred in six patients and four of them died. Seven patients suffered from chronic graft versus host disease. Seven patients relapsed and died. The median relapse time was 10 (3-24) months. Fourteen patients are still surviving, and ten have disease free survival.
It is concluded from our observation that HLA haploidentical peripheral blood stem cells transplantation may be an effective therapy for refractory and relapse leukemia. Some patients with refractory and relapse leukemia treated with HLA haploidentical stem cells transplantation may have disease free survival. Graft versus leukemia effect may be strong in patients receiving HLA haploidentical blood stem cells transplantation and leukemia will probably be relapsed when the patient without complete remission was treated with this therapy.
评估HLA单倍体相合干细胞移植治疗难治性白血病患者的疗效。
分析1998年8月至2004年8月间30例行HLA单倍体相合外周血干细胞移植的难治性白血病患者的疗效。
30例难治性白血病患者，其中急性非淋巴细胞白血病13例，急性淋巴细胞白血病（ALL）10例，慢性粒细胞白血病6例，IV期非霍奇金淋巴瘤1例，接受了HLA单倍体相合外周血干细胞移植。中位年龄25岁（3 - 52岁）。12例患者接受来自父母供者的干细胞，4例来自子女供者，其余来自同胞供者。12例患者HLA三个位点不相合，13例患者HLA两个位点不相合，5例患者HLA一个位点不相合。预处理方案包括氟达拉滨（25mg/m²×5天）、白消安（4mg/kg×4天）和环磷酰胺（60mg/kg×2天）。部分患者在预处理方案中加用兔抗人淋巴细胞球蛋白（5mg/kg×5天）。平均输入5.0（2.9 - 8.0）×10⁸/kg单个核细胞。平均CD34⁺细胞数为5.5（3.0 - 6.5）×10⁶/kg。27例患者成功植入，1例植入失败，1例在第2天死于严重真菌感染，1例在第28天死于严重肝静脉闭塞病。白细胞计数超过1.0×10⁹/L的平均时间为14（11 - 18）天，血小板计数超过20×10⁹/L的平均时间为15（11 - 18）天。27例成功植入的患者均获得完全缓解。6例患者发生严重急性移植物抗宿主病，其中4例死亡。7例患者发生慢性移植物抗宿主病。7例患者复发死亡。中位复发时间为10（3 - 24）个月。14例患者仍存活，10例患者无病生存。
我们的观察结果表明，HLA单倍体相合外周血干细胞移植可能是治疗难治性和复发性白血病的有效方法。一些接受HLA单倍体相合干细胞移植治疗的难治性和复发性白血病患者可能实现无病生存。接受HLA单倍体相合造血干细胞移植的患者移植物抗白血病效应可能较强，未完全缓解的患者接受该治疗后白血病可能复发。
