HLA半相合血缘性骨髓移植治疗慢性粒细胞白血病4例  

Treatment of CML With HLA haploidentical related bone marrow transplantation: report of Four cases and literature review

作　　者：虞荣喜[1] 周郁鸿[1] 沈建平[1] 林圣云[1] 胡致平[1] 罗秀素[1] 郑智茵[1] 陈均法[1] 沈一平[1] 叶宝东[1] 严正松[1] 

机构地区：[1]浙江省中医院,杭州310006

出　　处：《内科急危重症杂志》2005年第3期119-121,共3页Journal of Critical Care In Internal Medicine

摘　　要：目的:探索半相合未去除T细胞骨髓移植治疗慢性粒细胞白血病的可行性。方法:4例慢性粒细胞白血病患者接受HLA1或2个位点不相合亲缘骨髓移植。用阿糖胞苷、环磷酰胺和全身照射进行预处理,供者应用GCSF250μg/d,连用7d后采髓。移植物抗宿主病(GVHD)预防除用环孢菌素A(CsA)和甲氨蝶呤(MTX)外,在移植前第4天～第1天用抗胸腺细胞球蛋白ATG(兔抗)2.5mg/(kg·d),移植后第7天开始加用霉酚酸酯1.0g/d。结果:患者移植后均获得造血重建,中性粒细胞>0.5×109/L和血小板>20×109/L的中位时间分别是12.5(10～14d)和22d(18～25d)。4例患者发生急性Ⅰ度GVHD,其中1例2个位点不相合者进展为急性肠道和肝脏Ⅳ度GVHD,于+81d合并感染死亡。1例发生迟发性出血性膀胱炎。中位随访时间20个月(5～25个月)。无病存活3例,其中2例存活在1年以上。结论:供者应用GCSF后采髓,多种免疫抑制剂联合应用的HLA不全相合未去除T细胞骨髓移植,在治疗慢性粒细胞白血病过程中,有效地降低了急性重症GVHD发生,提高了无病生存。Objective:To explore the feasibility of allogeneic bone marrow transplantation (Allo-BMT) with graft from HLA haplotype matched related donor without T-cell depletion for the treatment of CML.Methods:Four patients with CML received allo-BMT with grafts from 1or 3 HLA antigen mismatched related donors. All patients were treated with standardized conditioning regimen consisting of high dose Ara-C , cyclophosphamide(CY) and total body irradiation (TBI) . Donors were given G-CSF 3 to 4 μg/(kg·d)for seven days prior to marrow harvest. GVHD prophylaxis programme consisted of CsA , MTX,ATG and mycophenolate mofetial.Results:All patients established successful engraftment. The median days of granulocyte > 0.5×10~9/ L and platelet > 20×10~9/ L were 12.5(range 10～14) and 22(range 18～25) days , respectively. All patient present gradeⅠaGVHD . one of them advanced to grade Ⅳgut and liver aGVHD and died of concurrent infection eventually . Another one developed delayed hemorrhagic cystitis.Chronic GVHDs were seen in 3 evaluable patients and none developed extensive cGVHD. The median follow-up duration was 620(150~745) days. Three patients were alive in a disease-free situation. Two of them survived more than one year.Conclusion The major histoincompatibility barriers in the haplotype matched related donor/ recipient allo-BMT might be crossed by donor stimulated with G-CSF and combined GVHD prophylaxis program.This provides one new way for the treatment of CML.

关 键 词：HLA半相合 骨髓移植 亲缘供者 慢性粒细胞白血病 

分 类 号：R551[医药卫生—血液循环系统疾病]