高伟波-干细胞移植.ppt

INDICATIONS FOR BLOOD AND MARROW TRANSPLANTATION IN NORTH AMERICA 2000 SUM02_45.ppt TRANSPLANTS 4,500 0 500 1,000 1,500 2,000 Non-Hodgkin Lymphoma AMLCMLHodgkin Disease Ovarian Cancer Allogeneic (Total N = 6,700) Autologous (Total N = 11,000) 2,500 3,000 4,000 3,500 Multiple Myeloma Breast Cancer ALLMDS/Other Leukemia Other Cancer Non-Malignant Disease CLL ANNUAL NUMBERS OF BLOOD AND MARROW TRANSPLANTS WORLDWIDE 1970-2000 MDM01_21.ppt NUMBER OF TRANSPLANTS YEAR 197019751980198519901995 0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 Autologous Allogeneic 2000 AUTOLOGOUS STEM CELL SOURCES BY AGE 1995-2000 SUM02_28.ppt % OF TRANSPLANTS 100 0 20 40 60 80 1995-19971998-20001995-19971998-2000 Bone Marrow (BM) Peripheral Blood (PB) BM + PB Age 20 yrsAge 20 yrs 化疗 诱导缓解或大剂量化疗 减少体内肿瘤负荷 采集造干细胞预处理回输和支持治疗 重建造血免疫系统 PROBABILITY OF SURVIVAL AFTER AUTOTRANSPLANTS FOR AML AGE 20 YEARS, 1994-1999 PROBABILITY, % 100 0 20 40 60 80 0 YEARS SUM02_8.ppt P = 0.0001 123465 CR1 (N = 209) CR2+ (N = 64) Not in remission (N = 29) PROBABILITY OF SURVIVAL AFTER AUTOTRANSPLANTS FOR AML AGE 20 YEARS, 1994-1999 PROBABILITY, % 100 0 20 40 60 80 0 YEARS 12346 SUM02_9.ppt P = 0.0001 5 CR1 (N = 991) CR2+ (N = 378) Not in remission (N = 244) PROBABILITY OF SURVIVAL AFTER AUTOTRANSPLANTS FOR ALL, 1994-1999 PROBABILITY, % 100 0 20 40 60 80 0 YEARS 12346 SUM02_10.ppt P = 0.0001 5 CR1 (N = 187) CR2+ (N = 168) Not in remission (N = 61) PROBABILITY OF SURVIVAL AFTER TRANSPLANTS FOR CLL, 1994-1999 PROBABILITY, % 100 0 20 40 60 80 0 YEARS 12346 SUM02_11.ppt P = 0.0001 5 Autologous (N = 164) HLA-identical sibling (N = 316) PROBABILITY OF SURVIVAL AFTER AUTOTRANSPLANTS FOR HODGKIN DISEASE, 1994-1999 PROBABILITY, % 100 0 20 40 60 80 0 YEARS 12346 SUM02_16.ppt P = 0.0001 5 CR1 (N = 184) CR2+ (N = 734) Never in remission (N = 632) Relapse (N = 1,806) PROBABILITY OF SURVIVAL AFTER AUTOTRANSPLANTS FOR FOLLICULAR NON-HODGKIN LYMPHOMA, 1994-1999 PROBABILITY, % 100 0 20 40 60 80 0 YEARS 12346 SUM02_17.ppt P = 0.0009 5 CR1 (N = 150) CR2+ (N = 296) Never in remission (N = 358) Relapse (N = 894) PROBABILITY OF SURVIVAL AFTER HLA-IDENTICAL SIBLING TRANSPLANTS FOR FOLLICULAR NON-HODGKIN LYMPHOMA, 1994-1999 PROBABILITY, % 100 0 20 40 60 80 0 YEARS 12346 SUM02_18.ppt P = NS 5 CR1-3 (N = 89) Never in remission (N = 126) Relapse (N = 188) PROBABILITY OF SURVIVAL AFTER AUTOTRANSPLANTS FOR DIFFUSE LARGE CELL LYMPHOMA, 1994-1999 PROBABILITY, % 100 0 20 40 60 80 0 YEARS 12346 SUM02_19.ppt P = 0.0001 5 CR1 (N = 362) CR2+ (N = 657) Relapse (N = 1,746) Never in remission (N = 911) 879) 级级 别别 皮皮 肤肤 （ 体体 表表 面面 积积 % ） 肝肝 脏脏 胆胆 红红 素素 （ um ol/L ） 肠肠 道道 腹腹 泻泻 量量m l/天天 0 无 皮 疹 34 500 + 斑 丘 疹 1500m l + 全 身 性 红 皮 和 伴 大 疤 形 成 表 皮 剥 脱 255 2000m l 严 重 腹 痛 伴 或 不 伴 肠 梗 阻 注注 ： 也也 有有 将将 肠肠 道道 分分 级级 定定 为为 ： 腹腹 泻泻 量量 ： 30m l/kg 60m l/kg 90m l/kg 严严 重重 腹腹 症症 伴伴 或或 不不 伴伴 肠肠 梗梗 阻阻 分分度度 皮皮肤肤 肝肝脏脏 肠肠道道 + + 基基底底层层细细胞胞空空泡泡变变性性或或坏坏死死 叶叶间间胆胆小小管管变变性性 和和/ /或或坏坏死死 7 75 5% % 弥弥漫漫性性粘粘膜膜裸裸露露 S. Slavin, et al: Blood, 1998,91: 756-763 S. Slavin, et al: Blood, 1998,91: 756-763