异基因造血干细胞移植治疗恶性血液病临床疗效分析  

Analysis study on allogeneic stem cells transplantation in malignant hematopathy

作　　者：靖彧[1] 于力[1] 刘海川[1] 姚善谦[1] 楼方定[1] 张伯龙[1] 高春记[1] 周绮[1] 李红华[1] 薄剑[1] 王全顺[1] 赵瑜[1] 朱海燕[1] 

机构地区：[1]解放军总医院血液科,北京100853

出　　处：《生物医学工程与临床》2008年第3期198-202,共5页Biomedical Engineering and Clinical Medicine

摘　　要：目的总结162例异基因造血干细胞移植(allo-HSCT)[包括:同胞allo-HSCT125例,非血缘关系allo-HSCT30例和非清髓异基因外周血造血干细胞移植(allo-PBSCT)7例]治疗恶性血液病疗效和生存状况。方法慢性粒细胞白血病(CML)患者62例,急性髓系白血病(AML)患者58例,急性淋巴细胞白血病(ALL)患者28例,骨髓增生异常综合征(MDS)6例,多发性骨髓瘤(MM)3例,非霍奇金淋巴瘤(NHL)3例,慢性粒单细胞性白血病(CMML)1例,霍奇金淋巴瘤(HD)1例。经预处理,进行人类白细胞抗原(HLA)相合的同胞异基因骨髓移植(allo-BMT)27例,allo-PBSCT98例和非血缘关系allo-BMT4例,非血缘关系allo-PBSCT26例,HLA相合的同胞非清髓allo-PBSCT7例。非血缘关系allo-HSCT患者采用长程加强的移植物抗宿主病(GVHD)的预防方案(将环孢菌素A提前至预处理开始时使用,同时加用霉酚酸酯)。结果移植后中位随访38(2～259)个月。allo-HSCT患者长期DFS为54.9%(89/162),CML至今DFS为61.3%(38/62),AML至今DFS为56.9%(33/58),ALL至今DFS为39.3%(11/28),MDS至今DFS为83.3%(5/6),3例NHL存活1例,1例CMML存活,3例MM均死亡,霍奇金淋巴瘤(HD)1例死亡。移植后100d内移植相关死亡率(TRM)19.8%(32/162),死亡原因分别为急性GVHD、播散性感染、复发和植入失败;移植后100d至2年内TRM为24.7%(40/162),死亡原因分别为慢性GVHD、CMV感染和疾病复发,1例于移植后1413d死亡,其余移植超过2年均存活,死亡原因是慢性GVHD合并感染,最长生存已11年。结论allo-HSCT可使相当部分白血病患者获得长期无病存活,治疗MDS效果良好,治疗MM效果很差。该组患者移植后100d内死亡原因主要是急性GVHD;移植后100d至2年内死亡的主要原因是慢性GVHD和CMV感染、疾病复发;故除正确处理移植相关并发症、减少移植手术期死亡之外,还应加强患者移植后的医学监护和康复指导,进一步提高移植成功率。Objective To summarize and analyze the clinical efficacy of allogeneic stem cell transplantation （allo-HSCT） in malignant hematopathy. Methods A total of 162 patients （CML 62 cases,AML 58 cases,ALL 28 cases,MDS 6 cases,MM 3 cases, NHL 3 cases, CMML 1 case, HD 1 case） were treated with allogeneic stem cells transplantation （HLA-matched sibling donor allo-BMT 27 cases, allo-PBSCT 98 cases, unrelated allo-BMT 4 cases, allo-PBSCT 26 cases, HLA-matched sibling donor nonmyeloablative allo-BMT 7 cases）. Results The median following-up time was 38 （2 - 259） months after transplantation. The disease-free survival rate was 54.9 % （89/162） in patients treated with allogeneic stem cells transplantation. The disease- free rate was 61.3 %（38/62） in CML patients,56.9 %（33/58） in AML patients ,39.3 %（11/28） in ALL patients ,83.3 %（5/6） in MDS patients and 1 of 3 patients with NHL, 1 patient with CMML were survival without disease ,respectively. But 3 patients with MM, 1 patient with HD died. Transplant-related mortality was 19.8 % （32/162） within 100 days post transplantation including acute GVHD ,early relapse ,disseminated infections ,and implant failure. Transplant-related mortality was 24.7 % in 100 days to 2 years post transplantation including CMV interstitial pneumonia,and chronic GVHD. There was no death case in 2 years after transplantation except 1 patient died from chronic GVHD in 1 413 days after transplantation ,and the longest survival prolonged more than 11 years. Conclusion Allogeneic stem cell transplantation is an effective treatment approach to achieve the disease free survival in malignant hematopathy patients. In the study the main cause for early death was acute GVHD,and the main causes for late death were chronic GVHD,CMV infection and disease relapse. It should pay attention to manage the complications associated with transplantation and provide monitoring and guidance to patients for getting recovery after transplantation.

关 键 词：异基因造血干细胞移植 白血病 治疗 

分 类 号：R733[医药卫生—肿瘤]