异基因造血干细胞移植后慢性移植物抗宿主病的临床分析  

Clinical study of chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation

作　　者：夏凌辉[1] 邹萍[1] 胡俊斌[1] 游泳[1] 方峻[1] 郭涛[1] 刘芳[1] 张纯[1] 崔国惠[1] 谢薇[1] 宋善俊[1] 

机构地区：[1]华中科技大学附属协和医院血液病研究所,武汉430022

出　　处：《中华器官移植杂志》2007年第7期428-432,共5页Chinese Journal of Organ Transplantation

摘　　要：目的探讨异基因造血干细胞移植(allo-HSCT)后慢性移植物抗宿主病(cC-VHD)的临床特点、相关危险因素及治疗效果。方法回顾性分析69例allo-HSCT患者的临床资料。根据供、受者的关系以及配型情况,将患者分为三组:A组为亲缘全相合异基因骨髓移植,22例;B组为亲缘全相合异基因外周血干细胞移植,37例;C组为非血缘移植和不全相合移植,10例。术前均采用化疗预处理,术后采用短程甲氨蝶呤联合环孢素A(CsA)预防移植物抗宿主病(GVHD)。局限性cGVHD患者多采用单一免疫抑制剂(CsA或糖皮质激素)治疗,病情进展者采用标准方案(CsA联合糖皮质激素)治疗;广泛性cGVHD患者则需用标准方案治疗(一线治疗方案)。一线治疗无效、病情进展者,对一线治疗依赖不能停药,或停药后病情反复者,需用他克莫司、霉酚酸酯及硫唑嘌呤治疗(二线治疗方案)。结果移植后随访6～120个月,中位时间为43个月,39例诊断为cGVHD,其中局限性cGVHD 13例(33.3%,13/39),广泛性cGVHD 26例(66.7%,26/39),7例死于cGVHD或与之相关的并发症。B组cGVHD发生率较A组显著升高(P<0.05),B组和C组的广泛性cGVHD发生率显著高于A组(P<0.05)。外周血干细胞移植和病程中发生2～4度急性GVHD是cGVHD发生的主要危险因素。局限性cGVHD患者采用一线方案治疗的有效率显著高于广泛性cGVHD患者(P<0.05),标准危险度cGVHD者的治疗有效率显著优于高危险度cGVHD者(P<0.05)。结论cGVHD是allo-HSCT后常见并发症和致死原因;广泛性cGVHD多发生于异基因外周血干细胞移植、HLA配型不全相合移植和非血缘移植,且临床治疗效果不佳。Objective To investigate the clinical characteristics, associated risk factors and therapeutic effectiveness of chronic graft-versus-host disease （cGVHD） after allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Methods The clinical data of cGVHD were retrospectively analyzed from 69 patients who underwent allo-HSCT. All patients were divided into three groups according to the relation between donor and recipient and HLA matching： 22 patients of siblingmatched bone marrow transplantation in group A; 37 patients of sibling-matched peripheral blood stem cell transplantation in group B; 10 patients of matched unrelated donor HSCT or sibling-mismatched HSCT in group C. All of them were subjected to chemotherapy for preconditioning before transplantation, and short-term methoterexate （MTX） combined with cyclosporine （CsA） for GVHD prophylaxis after transplantation. Patients with limited cGVHD were usually treated with immunosuppressive agent （CsA or glucocortlcoid） alone, and those with advanced condition were administrated with standard regimen （CsA combined with glucocorticoid） ; while those with extensive cGVHD were treated with standard regimen （first line therapy）. Those who were not responsive to first line therapy and had a progressive disease condition, or those who were refractory to the first line therapy and relapsed when drug withdrawal were treated with tacrolimus, mycophenolate and azathioprine （second line therapy）. Results During a median follow-up period of 43 months （6-120 months）, 39 patients developed cCVHD after transplantation. Limited cGVHD developed in 13 of 39 patients （33. 3 %）, while extensive cCVHD developed in 26 of 39 patients （66. 7 %）. Seven died of cGVHD or related compli-cations, cGVHD incidence in group B was much higher than in group A （P〈0. 05）, while incidence of extensive cGVHD in groups B and C were muchhigher than in group A （P〈0. 05）. Peripheral blood stem cell transplant and development of grade Ⅱ -Ⅳ ac

关 键 词：造血干细胞移植 移植物抗宿主病 治疗结果 

分 类 号：R55[医药卫生—血液循环系统疾病] R457.7[医药卫生—内科学]