ABO血型不合的非清髓异基因外周血干细胞移植  

ABO-incompatible Nonmyeloablative Allogeneic Peripheral Blood Stem Cell Transplantation

作　　者：孙万军[1] 郭梅[1] 乔建辉[1] 余长林[1] 王丹红[1] 孙琪云[1] 张石[1] 李新[1] 艾辉胜[1] 

机构地区：[1]军事医学科学院附属医院血液科,北京100039

出　　处：《中国实验血液学杂志》2005年第1期39-42,共4页Journal of Experimental Hematology

基　　金：解放军总后勤部"十五"医学基金重点课题"非清髓性异基因造血干细胞移植的临床和基础研究";编号 0 1Z0 3 0

摘　　要：为了探讨ABO血型不合对HLA相合的非清髓异基因外周血干细胞移植 (NAST)的影响 ,回顾分析了 15例ABO血型主要不合 ,9例次要不合的HLA相合的NAST的临床特点 ,并选用同期ABO血型相合的NAST作成组比较。结果显示 :2 4例ABO血型不合的NAST受者在输入供者外周血干细胞悬液时无 1例发生急性溶血 ,但有2例发生迟发性溶血。统计学分析表明 ,ABO血型不合对NAST骨髓植活、血小板恢复、GVHD、疾病复发及无病生存均无影响。在ABO血型主要不合组 ,红系开始恢复时间明显延迟 ,其中 1例“O”型血受者发生纯红细胞再生障碍 ,持续 5个月。结论 :ABO血型不合不是NAST的障碍 ,仅在ABO血型主要不合时 ,红系恢复时间延迟。To explore the effects of ABO incompatibility between recipient and donor on HLA-matched nonmyeloablative allogeneic peripheral blood stem cell transplantation (NAST), a retrospective, cohort study was performed. Among 24 HLA-matched NAST, 15 were major ABO-incompatible and 9 minor. Control group included 24 HLA-matched NAST with ABO-compatible grafts. Nonmyeloablative conditioning regimens consisted of CTX, Ara-C and ATG. The patients were given cyclosporine A and mycophenolate mofetile for prophylaxis of acute GVHD. The ABO-incompatible patients received grafts depleted erythrocytes by hydroxyethyl starch (HES) sedimentation. The results showed that successful and stable engraftment was established in 23 patients. No recipient developed clinically immediate hemolysis during graft infusion, but 2 recipients experienced delayed hemolysis attributable to the ABO incompatibility. The median time of granulocyte counts >0.5×109/L and platelet >30×109/L was 11 and 14.9 days, respectively. In ABO major incompatible group, the onset of erythropoiesis after NAST was delayed. One out of 10 recipients with blood group “O” in this group developed pure red cell aplasia (PRCA), lasting 5 months. The acute GVHD occurred in 7 out of the 24 patients. The chronic GVHD occurred in 5 of 21 cases. Relapse was observed in 2 patients with acute leukemia. The actuarial probability of disease-free survival at 2 years was 63.3%. In conclusion, ABO-incompatible grafts for NAST have no adverse effect on engraftment, recovery of platelets, incidence of GVHD, relapse rate or survival. ABO-incompatible NAST is fairly safe if there is indication, however, the onset of erythropoiesis is delayed when major ABO mismatched.

关 键 词：外周血干细胞移植 非清髓异基因外周血干细胞移植 ABO血型不合 

分 类 号：R457.11[医药卫生—治疗学] R457.7[医药卫生—临床医学]