非去T细胞单倍型相合的造血干细胞移植31例临床分析  

A clinical study of 31 patients with malignant hematopoietic disease treated with non-T cell-depleted HLA-haploidentical hematopoietic stem cell transplantation

作　　者：杨明珍[1] 袁燕慧[1] 吴德沛[1] 常伟荣[1] 何军[1] 狄文英 

机构地区：[1]苏州大学附属第一医院血液科,江苏省血液研究所215006 [2]苏州市中心血站

出　　处：《中华内科杂志》2007年第6期482-485,共4页Chinese Journal of Internal Medicine

基　　金：卫生部科研基金(wkj2004-2-005);江苏省医学重点人才基金(RC2002033);江苏省"六大人才高峰"培养基金

摘　　要：目的探讨 HLA 单倍型相合造血干细胞移植(HSCT)对恶性血液病的疗效及其预后。方法总结2002年7月至2006年7月在我院治疗的31例恶性血液病患者(标危组11例,高危组20例)接受 HLA 单倍型相合 HSCT 临床资料,分析急性移植物抗宿主病(aGVHD)发生及其相关因素。结果 31例患者中30例获得稳定的造血重建,移植后中性粒细胞>0.5×10~9/L 及血小板>20×10~9/L 的中位时间分别为13d 和22d,发生Ⅱ～Ⅳ度 aGVHD 的累积发生率为61.3%,慢性 GVHD 的累积发生率为41.9%。标危组33个月累积无病生存率(DFS)为62.3%,高危组33个月的 DFS 为35.0%。移植物中 CD_3^+ T 细胞数量和供受体 HLA-A、B、DR 位点不相合的程度是影响 aGVHD 发生的主要因素。结论 HLA 单倍型相合的 HSCT 对于恶性血液病是一种有效的治疗方法,移植物中CD_3^+T 细胞数量和 HLA-A、B、DR 位点不相合的程度是影响单倍型相合的 HSCT 的 aGVHD 发生的主要因素。Objective To investigate the effects and prognosis of malignant hematological disease after HLA haploidentical hematopoietic stem cell transplantation （H-HSCT） without T-cell depletion. Methods The clinical data of 31 cases with malignant hemopoietic disease treated with H-HSCT from July 2002 to July 2006 were analyzed, including 11 cases of standard risk and 20 of high risk. Results 30 patients achieved engraftment of a median of 13 and 22 days for neutrophil and platelet, with an accumulative incidence of II -IV grade acute graft-versus-host disease （GVHD） 61.3% ,and an accumulative incidence of chronic GVHD 41.9%. 13 patients survived with Karnofsky scale over 90. 0% after a median follow-up of 24 months. 33 months of accumulative survival was 62. 3% in the standard risk group and 35.0% in the high risk group. The CD3^＋ T cells count of the graft and the disparity of HLA-A,B,DR loci were the major factors of impact on acute GVHD. Conclusion HLA H-HSCT is an effective therapeutic method for malignant hematological disease, CD3^＋ T cells count of the graft and the disparity of HLA-A, B, DR loci are the major factors of impact on acute GVHD.

关 键 词：白血病 造血干细胞移植 单倍型 移植物抗宿主病 

分 类 号：R733[医药卫生—肿瘤]