Treatment of Chronic Myelocytic Leukemia by Allogeneic Bone Marrow Transplantation in Eleven Patients

十一位慢性骨髓性白血病患者接受異體骨髓移植的治療經驗

何景良(Ching-Liang Ho) ； 陳宇欽(Yeu-Chin Chen) ； 黃柏仁(Wei-You Kao) ； 高偉堯(Po-Jen Haung) ； 趙祖怡(Tsu-Yi Chao)

《Journal of Medical Sciences》 20卷2期 (1999/10) Pp. 103-110

摘要

在本院從1986年至1998年，有11位慢性骨髓性白血病患者接受異體骨髓移植，其中8位男性，3位女性，年齡從18至40歲，平均年齡24歲，有10位患者接受親屬骨髓移植，其中8位為組織抗原配對完全相合，有2位為組織抗原配對一組不合，另外只有1位接受組織抗原配對完全相合之非親屬移植。11位病人中，有8位患者在疾病慢性期，2位在加速期，1位在急性血癌期接受骨髓移植。在最早的4位病患接受的移植前的調適治療為全身放射治療及高劑量化學治療（TBI-CY2），之後的7位病患接受的調適治療為高劑量化學冶療（BU-CY2）。所有病患均接受環孢靈素及短療程的methotrexate來預防移植物抗宿主疾病。11位患者中，有9位患者移植成功，有3位患者產生急性移植物抗宿主疾病，及1位患者產生慢性移植物抗宿主疾病，特別的是在3位接受組織抗原配對不合及組織抗原配對完全相合之非親屬移植中，並沒有移植物抗宿主疾病的發生，在9個移植成功的病人追蹤了2至87個月，移植後的疾病消失期平均有9個月。在8個慢性期患者接受骨髓移植治療後，有6個患者目前仍存活，其他的5位患者死亡，其原因有：2位移植失敗，2位疾病復發，1位間質性肺炎。在7位使用BU-CY2為調理性治療的患者中，六位目前仍存活，然而所有接受TBI-CY2為調理性治療的患者均死亡，在唯一接受非親屬的骨髓移植患者，目前已存活36個月。我們的結果有三點結論：1.BU-CY2是相當有效的調適性治療；2.在慢性骨髓性白血病的慢性期接受骨髓移植有機會長期存活；3.一組組織抗原不合的親屬及組織抗原完全相合的非親屬也是可以考慮的適合捐贈者。

關鍵字

骨髓移植 ； 慢性骨髓性白血病 ； 移植物抗宿主疾病 ； 間質性肺炎

並列摘要

Eleven patients of chronic myelocytic leukemia (CML) were treated with allogeneic bone marrow transplantation (BMT) from 1986 to 1998 in our institute. There were 8 men and 3 women with age ranging from 18 to 40 years old. Ten patients received marrow from a related donor, of which 8 patients were HLA-fully-matched and 2 patients were HLA-1-locus mismatched. The other patient received HLA-fully-matched marrow from an unrelated donor (MUD). Eight patients received BMT in chronic phase (CP), 2 in accelerated phase, and 1 in blastic crisis. The initial four consecutive patients received total body irradiation and cyclophosphamide (TBI-CY2), and the other 7 patients received busulfan and cyclophosphamide (BU-CY2) as the conditioning regimen. All of them received cyclosporine and a short course of methotrexate for prophylaxis of graft-versus-host disease (GVHD). Nine patients achieved engraftment successfully. Acute GVHD occurred in 3 of the 11 patients and chronic GVHD in 1 of the 3 patients who developed acute GVHD. No GVHD developed in those patients who received marrow from HLA-1-locus-mismatched sibling donors and MUD. The overall median disease-free survival time of the 9 engrafted was 9^+ months with a follow-up time of 2 to 87 months. Six out of 8 patients who received BMT in CP are still alive, while the others have died of engraftment failure (2), disease relapse (2), and interstitial pneumonitis (1). The patient who received MUD is still alive without evidence of disease for 36 months. Our results are in agreement with previous studies showing that BU-CY2 is an effective and well tolerated conditioning regimen for BMT in CML patients. Patients with CML receiving BMT in CP carry the best chance for achieving long term survival. HLA-1-locus-mistached sibling and MUD could be considered suitable donors for allogeneic BMT in CML patients.

並列關鍵字

bone marrow transplantation ； chronic myelocytic leukemia ； graft-versus-host-disease ； interstitial pneumonitis