无血缘关系供者外周血干细胞移植和骨髓移植治疗白血病的比较  

Comparison of clinical outcomes between unrelated donor peripheral blood stem cell transplantation and bone marrow transplantation for leukemia

作　　者：范志平[1] 杨凯[1] 孙竞[1] 徐丹[1] 张钰[1] 魏永强[1] 叶昌雄[1] 江千里[1] 孟凡义[1] 刘启发[1] 

机构地区：[1]南方医科大学南方医院血液科,广州510515

出　　处：《中华血液学杂志》2006年第8期525-528,共4页Chinese Journal of Hematology

摘　　要：目的比较无血缘关系供者外周血干细胞移植和骨髓移植在造血重建、T 细胞重建、感染、移植物抗宿主病(GVHD)及疗效等的差异。方法 53例白血病患者中,21例接受无血缘关系供者外周血干细胞移植(PBSCT 组),32例接受无血缘关系供者骨髓移植(BMT 组)。统计分析二者移植后白细胞和血小板重建时间、T 细胞重建、感染率、GVHD、白血病复发、无病生存(DFS)情况。结果PBSCT 组和 BMT 组移植后白细胞重建时间分别为(12.43±3.67)天和(16.16±2.99)天(P<0.01),血小板重建时间分别为(14.67±6.19)天和(21.23±8.25)天(P<0.01)。PBSCT 组和 BMT 组移植后1,3,6,9及12个月的 T 细胞重建差异无统计学意义。PBSCT 组和 BMT 组移植后早期感染率分别为42.86%和53.13%(P>0.05)。PBSCT 组与 BMT 组急性 GVHD 的发生率分别为61.90% 和71.885(P>0.05);在可统计的患者中,慢性 GVHD 的发生率在 PBSCT 组和 BMT 组分别为47.06%和43.48%(P>0.05)。PBSCT 组与 BMT 组移植后分别有4例和2例复发,二者复发率差异无统计学意义(P>0.05);PBSCT 组与 BMT 组移植后2年 DFS 率分别为(50.14±12.00)% 和(59.81±8.99)%,二者差异也无统计学意义(P>0.05)。结论无血缘关系供者 PBSCT 后的造血重建比BMT,但二者移植后 T 细胞重建、感染发生率、GVHD 及 DFS 的差异均无统计学意义。Objective To compare the hemopoietic reconstitution, immune reconstitution, infection, incidence of graft-versus-host disease （GVHD） and clinical outcome between unrelated donor peripheral blood stem cell （PBSC） transplantation and bone marrow （BM） transplantation for leukemias. Methods The clinical results of 21 leukemia patients receiving G-CSF mobilized PBSC graft from unrelated donors were compared with that of 32 patients receiving unrelated BM transplants. Results Compared with BM grafts, the PBSC graft contained significantly more nucleated cells （ P = 0. 000）, and resulted in a significantly shorter time-to-neutrophil （ 12.43±3.67 vs 16.16±2.99 days） and platelet engraftment （ 14.67± 6.19 vs 21.23 ± 8.25 days） , （P=0.000 and 0.003, respectively）. T cell reconstitution between the two groups differed little after transplantation. The incidences of early-stage infection （42.86% vs 53.13% ）, the probabilities of acute graft-versus-host disease （aGVHD） （61.90% vs 71.88% ）, the grades Ⅲ to ⅣaGVHD （23.81% vs 15.63% ）, the chronic GVHD （47.06% vs 43.48% ） and the probabilities of relapse （6.90% vs 12.50% ） between PBSC and BM groups all has no statistical significance （NS）. The 2-year disease free survival （DFS） rates of the two groups were （50.14± 12.00） % and （ 59.81±8.99） %, respectively also have no NS. Conclusion G-CSF-mobilized unrelated donor PBSCs engraft more rapidly in the recipients as compared with conventional BM grafts. The T cell reconstitution, the incidence of infection, the incidence and severity of aGVHD and cGVHD, and the 2-year DFS rates between the two groups all have no significant differences.

关 键 词：造血干细胞移植 造血重建 免疫重建 移植物抗宿主病 

分 类 号：R733.7[医药卫生—肿瘤]