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題名 | Allogeneic Bone Marrow Transplantation for Children with Acute Lymphoblastic Leukemia in Second Remission or Relapse=同種異體髓移植治療再發後緩解之兒童急性淋巴性白血病 |
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作者 | 林凱信; 周獻堂; 陳榮隆; 林東燦; 雷德; 林國信; | 書刊名 | 中華民國小兒科醫學會雜誌 |
卷期 | 35:6 民83.11-12 |
頁次 | 頁487-494 |
分類號 | 417.5515 |
關鍵詞 | 骨髓移植; 顆粒性白血球生長素; 急性淋巴性白血病; BMT; rhG-CSF; Acute lymphoblastic leukemia; |
語文 | 英文(English) |
中文摘要 | 大部分兒童急性白血病(ALL)以化學治療能痊癒。但是,複發的ALL或高危險ALL,傳統成績不佳。所以達到下一次緩解期,以骨髓移植(BMT)來治療最爲恰當。三位罹患ALL的男孩,九至十三歲,合乎上述條件,而且各有織抗原相符合的姊妹可捐髓。從1989年3月至1992年5月間,接受BMT治療;先前調理以全身放射線(TBI)12GY加上高劑量(cytosine arabinoside 3gm/m^2/12×12doses,預防移植物抗宿主病(GVHD)則使用cyclosporine加上四劑methotrexate。三位病童BMT之後,染色體檢查顯示捐者骨髓都有生長,兩位病童有GVHD;一位病童在BMT5個月之後,白血病複發,染色體又回複到男性型,最後死於ALL。這種BMT前之調理,副作用包括:懼光、結膜炎以及皮膚疹,有一例甚至起水泡及嚴重脫皮。有一例使用二十一天的rhG-CSF,白血球數恢複迅速,但曾發生暫時性骨疼痛。本文之結論,以TBI加上高劑量cytosine arabinoside爲高危險群ALL病人作BMT治療,比傳統化學治療成績要好,將來需進一步研究如何降低BMT後ALL之複發率。 |
英文摘要 | Most children with acute lymphoblastic leukemia (ALL) are successfully treated by chemotherapy. For those patients, who relapse on therapy, bone marrow transplantation (BMT) is considered most appropriate after a subsequent remission is achieved. Three boys with ALL aged from 9 to 13 years met these criteria and received BMT from their HLA-compatible sisters after marrow ablation with total body irradiation 12 Gy plus high dose cytosine arabinoside 3 gm/m^2/12h×12 doses and graft-versus-host disease (GVHD) prophylaxis with cyclosporine plus short course methotrexate from March 10, 1989 to May 23, 1992. Filgrastim (rhG-CSF) was used to hasten the recovery of granulocyte in one patient. All three patients got full engraftment and two had grade] acute GVHD. None of them developed chronic GVHD. Two patients have disease-free survival over 51 and 12 months respectively post BMT without further chemotherapy. One patient died of recurrent refractory leukemia 5 months after BMT. The toxicity of this conditioning regimen included photophobia, conjunctivitis and erythematous skin rashes. One patient who received filgrastim from day I to 21 developed severe bone pain. However, this patient had faster recovery of granulocyte count than the other two patients. The preliminary results of this work favors BMTfor children with recurrent ALL whose ultimate survival is usually poor when treated with chemotherapy. Further efforts are necessary to investigate new methods for reducing leukemic relapse in ALL patients undergoing BMT. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。