异基因外周血造血干细胞移植治疗白血病

５例白血病患者接受ＨＬＡ相合异基因外周血干细胞移植。外周血干细胞动员采用供者连续皮下注射Ｇ－ＣＳＦ（１０μｇ／ｋｇ）５天，于第５天和第６天用ＣＳ３０００Ｐｌｕｓ血细胞分离机分离单个核细胞（ＭＮＣ）。患者平均输入ＭＮＣ６．０×１０８／ｋｇ，ＣＤ３４＋细胞２２．６×１０６／ｋｇ，ＣＤ３＋细胞４１２×１０６／ｋｇ，ＣＤ４＋细胞２０５×１０６／ｋｇ和ＣＤ８＋细胞１６２×１０６／ｋｇ。移植后造血重建迅速，中性粒细胞绝对计数＞０．５×１０９／Ｌ和血小板计数＞２０．０×１０９／Ｌ的平均时间分别为１３．４天和１１．４天。５例均未发生急性ＧＶＨＤ，２例发生慢性ＧＶＨＤ。供者对大剂量Ｇ－ＣＳＦ耐受良好     

异基因外周血造血干细胞移植后巨细胞病毒间质性肺炎

目的：探讨异基因外周血造血干细胞移植(Allo-PBSCT)后间质性肺炎（IP）的病因,危险因素及防治方法。方法;将Allo-PBSCT患者分为更昔洛韦（GCV）预防组18例和对照组（未预防组）22例,比较两组巨细胞病毒南性肺炎（CMV－IP）的发生率。结果：对照组Allo-PBSCT患者中并发CMV－IP5例,预防组无1例发生CMV－IP。发生CMV－IP的高危因素为女性供者,合并移植物抗宿主病（GVHD）。4例治愈,1例治疗无效死亡。结论：Allo-PBSCT后CMV感染是IP的主要病因,IP的发生与GVHD严重程度及妇性供者密切相关,GCV能有效预防和治疗CMV－IP。     

Allogeneic peripheral blood stem cell transplantation for leukemia

Objective To observe engraftment kinetics, the incidence and severity of graft-versus-ho st disease (GVHD), and clinical outcome on 40 recipients undergoing allogeneic p eripheral blood stem cell transplantation (allo-PBSCT).Methods From June 1997 to May 1999, forty leukemia patients with a median age of 35 year s underwent allo-PBSCT. PBSC were mobilized with G-CSF at a dose of 5 μg/kg s.c. every 12 hours for 5 days. A median of 7.7 (2.0-16.8)×10 (6) CD34(+) cells/kg was infused into the recipients. Busulfan-cyclophosphamid e (BU-CY) was used as the conditioning regimen. All patients received cyclospo rine A and either methotrexate (n=34) or methylprednisolone (n=6) for GVHD p rophylaxis. Results Engraftment of neutrophils and platelets was achieved at a median of 13 days (9 -28 days) and 12 days (7-60 days) respectively. Patients receiving ≥4×10 (6) CD34(+) cells/kg or given G-CSF post transplant had significantl y accelerated neutrophil and platelet engraftment. Acute GVHD occurred in 17 of 40 patients (42.5%), with grade Ⅱ-Ⅳ acute GVHD in 10 patients (25%). Chron ic GVHD developed in 21 (9 extensive, 12 limited) out of 30 evaluable patients ( 21/30, 70%) with a median follow up of 380 days (180-900 days). Transplan t related mortality was 17.5% and the relapse rate was 10%. The probability of leukemia free survival at 3 years was 72.5%.Conclusion Allo-PBSCT can provide rapid hematopoietic reconstitution without an increased incidence of acute GVHD, but may be associated with a high risk of chronic GVHD .     

异基因外周血造血干细胞移植治疗白血症

５例白血病患接受ＨＬＡ相合异基因外周血干细胞移植。外周血干细胞动员采用供连续皮下注射Ｇ－ＣＳＦ（１０μｇ／ｋｇ）５天，于第５天和第６天用ＣＳ３０００Ｐｌｕｓ血细胞分离机分离单个核细胞（ＭＮＣ）。患平均输入ＭＮＣ６．０×１０＾８／ｋｇ，ＣＤ３４＾＋细胞２２．６×１０＾６／ｋｇ，ＣＤ３＾＋细胞４１２×１０＾６／ｋｇ，ＣＤ４＾＋细胞２０５×１０＾６／ｋｇ和ＣＤ８＾８细胞１６２×１０＾６／ｋｇ。移植     

血清核苷二磷酸激酶A(NDPK-A)含量测定及其临床意义初探

[目的]研究血清核苷二磷酸激酶A(NDPK-A)含量与白血病的相关性,探讨血清NDPK-A含量检测对于白血病早期诊断和疗效判断意义。[方法]应用重组人NDPK-A及相应抗体建立双抗体夹心ELISA测定NDPK-A含量方法,应用此方法测定正常人和血液病患者血清NDPK-A含量。[结果]20例正常人血清NDPK-A含量为3.89±0.39μg/L,16例白血病患者血清NDPK-A含量为11.06±18.03μg/L,5例骨髓瘤患者患者血清NDPK-A含量为4.80±0.96μg/L,5例淋巴瘤患者血清NDPK-A含量为24.31±5.65μg/L。白血病患者治疗前后血清NDPK-A含量差异显著,7例治疗前患者NDPK-A含量为16.23±26.61g/L,治疗后患者NDPK-A含量为7.05±6.10g/L。[结论]建立的ELISA方法简单,灵敏、准确地测定血清NDPK-A含量;NDPK-A含量检测可发展为白血病的早期诊断和疗效判断指标。     

造血干细胞移植后检出人类多瘤病毒尿的临床分析

 目的 研究造血干细胞移植后潜伏于体内的人类多瘤病毒（HuPV）-BK病毒（BKV）和JC病毒（JCV）的激活情况。方法 连续采集41例患者造血干细胞移植前后及10例正常对照的尿样本，用实时定量PCR检测病毒，半巢式PCR鉴定BKV和JCV病毒株。结果 造血干细胞移植后病毒尿阳性的患者共33例（80％），其中出现BKV尿者15人（45％）、JCV尿者3人（9％），在相同或不同时段尿样本中检出两株病毒者11人（33％），另外4人（12％）未能鉴定出病毒株；比较24例病人移植前、后病毒尿发生率，分别为19％、77％，存在显著性差异（P〈0．0001）；正常对照组没有检测到病毒（P〈0．0001）。结论 造血干细胞移植后HuPV病毒尿的发生率明显升高，但影响因素仍不明确，可能是多因素综合作用的结果，其临床意义还有待进一步探讨。     

变异型Ph易位

变异型Ph易位包括单纯变异型,复杂变异型和隐匿型,其发生率约为Ph阳性CML的4～8%。变异型Ph易位具有与标准Ph易位相同的分子标志,即bcr-abl基因重组。变异型Ph染色体通过逐步易位或同步易位形成。变异型Ph易位CML患者的预后和血液学特征与标准型Ph易位CML患者无显著差异。一些Ph阴性CML在细胞遗传学未见Ph易位,但具有bcr-abl基因重组的分子遗传学证据。     

Cytomegalovirus interstitial pneumonitis following allogeneic peripheral blood stem cell transplantation

Objective： To explore the risk factors and prophylaxis and treatment of cytomegalovirus interstitial pneumonitis （CMV-IP） after allogeneic peripheral blood stem cell transplantation （allo-PBSCT）. Methods： 43 patients who received allo-PBSCT were allocated to either a Gancyclovir（GCV）-prophylaxis group （n=19） or a non-GCV prophylaxis group （n=24）. A comparison was made of the incidence of CMV-IP in patients given or not given prophylactic gancyclovir. Results： 9 patients in non-GCV prophylaxis group developed late CMV-IP （P〈0.05）. Graft-versus-host-disease （GVHD） may be associated with a high risk of CMV-IP. 5 cases of CMV-IP were successfully treated with GCV, but 3 cases died of CMV-IP. The most common adverse event of GCV was neutropenia, but was reversible. Conclusion： CMV infection was a major cause of interstitial pneumonitis after allo-PBSCT, which correlated strongly with the severity of GVHD. Gancyclovir was shown to be effective in both prophylaxis and treatment of CMV-IP.     

急性白血病患者辨证分型与血象、骨髓象及血、尿环核苷酸关系的临床观察

把59例急性白血病患者分为温毒瘀血、痰热症瘕、气阴两虚三型,观察其盘象、骨髓象和血、尿环核苷酸变化,发现各型与正常人比较均有显著差异,但程度并不一致。对32例患者治疗前后观察,气阴两虚型的缓解率较高,而温毒瘀血型较差。实验认为急白中医分型具有分子病理学基础。