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目的 评价双次自体造血干细胞移植 (DAHSCT)治疗急性淋巴细胞白血病 (ALL)的临床疗效及部分影响因素。方法 13例成人ALL患者获完全缓解 (CR) 12个月内行第 1次自体造血干细胞移植 ,以足叶乙甙 (Vp16 )总量 6 0 0～ 10 0 0mg[或阿糖胞苷 (Ara C) 2～ 4g/m2 ]+环磷酰胺 (CTX) 12 0mg/kg+分次全身照射 (TBI) 7.5～ 9.0Gy进行予处理 ,其中 6例一次性加用总量 12 5mg的卡氮芥 (BCNU) ;第1次自体造血干细胞移植术后 4～ 10个月进行第 2次自体造血干细胞移植 ,预处理方案为Vp16总量6 0 0～ 10 0 0mg(或Ara C 2～ 4g/m2 ) +马法兰 (Mel) 140mg/m2 +CTX 12 0mg/kg。结果 所有患者两次移植后均获造血重建 ,无一例移植相关死亡。中位随访时间 837(5 34～ 2 0 99)d ,存活 7例 (5 3.8% ) ,DAHSCT后 3年无病生存率 (5 3.8± 7.7) % ,复发死亡 6例 (4 6 .2 % ) ,第 2次移植时骨髓原始、幼稚淋巴细胞比例高于第 1次移植时 ,患者易于复发。结论 DAHSCT移植相关死亡率低 ,无病生存率较高 ,可以作为改善成人ALL患者治疗效果的重要措施
Objective To evaluate the clinical efficacy and some influencing factors of double-cell autologous stem cell transplantation (DAHSCT) in the treatment of acute lymphoblastic leukemia (ALL). Methods Thirteen adult ALL patients undergoing complete remission (CR) were treated with the first autologous hematopoietic stem cell transplantation within 12 months. The total amount of Vp16 was 600 ~ 100 mg [or Ara C ) 2 ~ 4g / m2] + cyclophosphamide (CTX) 120mg / kg + fractional whole body irradiation (TBI) 7.5-9.0Gy for treatment, of which 6 were added at a total amount of 125mg of BCN ). The second autologous hematopoietic stem cell transplantation was performed 4 to 10 months after the first autologous hematopoietic stem cell transplantation. The pretreatment program consisted of 60 to 100 mg of Vp16 (or Ara C 2 to 4 g / m 2) + Melphalan 140 mg / m2 + CTX 12 0 mg / kg. Results All patients underwent hematopoietic reconstructions after two grafts, and none of the patients died of transplantation. The median follow-up time was 837 (534 ~ 2 099) d, 7 patients (53.8%) survived, 3 years after DAHSCT, the disease-free survival rate was (3.8 ± 7.7)%, 6 patients (46.2% ), The second transplant when the bone marrow naive lymphocyte ratio is higher than the first transplant, the patient is easy to relapse. Conclusions The low death rate and high disease-free survival rate of DAHSCT can be used as an important measure to improve the therapeutic effect in adult patients with ALL