HLA单倍体相合非体外去T细胞外周血干细胞移植治疗恶性血液病36例  

Non-T-cell depleted HLA haploidentical peripheral blood stem cell transplantation for hematological malignancies： report of 36 cases

作　　者：袁海龙[1] 李玲[1] 曲建华[1] 温丙昭[1] 江明[1] 郝建萍[1] 陈瑢[1] 郭新红[1] 哈力达·亚森[1] 王善征[1] 丁凌录[1] 

机构地区：[1]新疆医科大学第一附属医院血液科、新疆血液病研究所,乌鲁木齐830054

出　　处：《中华血液学杂志》2009年第2期82-86,共5页Chinese Journal of Hematology

基　　金：基金项目：新疆维吾尔自治区高技术研究与发展计划（200511109）

摘　　要：目的探讨亲属间HLA单倍体相合外周血干细胞移植（PBSCT）治疗恶性血液病的疗效。方法恶性血液病患者36例，中位年龄25（11～48）岁，供受者人类白细胞抗原（HLA）配型1个位点不合者7例，2～3个位点不合者29例。移植方案采用清髓性预处理及联合免疫抑制剂预防移植物抗宿主病（GVHD）进行非体外去T细胞的PBSCT，移植的CD34^＋细胞中位数为11（4．16～21．00）×10^6／kg。结果36例患者均获得完全、持久供者造血干细胞植入，发生急性GVHD（aGVHD）15例（41．7％），均为Ⅰ-Ⅱ度；存随访时间超过18个月的29例患者中发生慢性GVHD（cGVHD）17例（58．6％）。移植后T、B、NK细胞亚群下降及恢复与HLA位点全相合移植患者差异无统计学意义。36例患者中位随访时间为15（4～69）个月，复发5例，累计复发率为13．9％。现无自血病存活30例，2年预期总无白血病生存率（LFS）为82．2％。结论应用清髓性预处理联合多种免疫抑制剂进行非体外去T细胞亲属间HLA单倍体相合PBSCT是治疗恶性血液病安全有效的方案。Objective To analyze the clinical outcome of human leukocyte antigen （HLA） hapoidentical peripheral blood stem cell transplantation （PBSCT） from related donors for hematological malignancies. Methods Thirty-six patients with hematological malignancies, with a median age of 25 （ 11 - 48 ） years, were transplanted with PBSC from an HLA-haploidentical family donors： 7 were 1 locus mismatched and 29 were 2 -3 loci mismatched. The recipients received myeloablative conditioning regimen, in combination with different immunosuppressants according to the degree of HLA disparity followed by non-T-cell depleted PBSCT. The median number of CD34^＋ cells were 11 （4.16 - 21.00） × 10^6/kg. Results All patients achieved sustained,full donor-type engraftment. Fifteen patients（41.7% ） developed grade Ⅰ - Ⅱ aGVHD. Among 29 patients followed up more than 18 months,17 （58.6%） developed cGVHD. There was no statistical difference in decrease and recovery of T, B and NK cell subsets after transplantation between HLA haploidentical group and HLA identical PBSCT group. The median follow-up duration was 15 （4 -69） momths. Five patients （ 13.9% ） relapsed. The 2-year probability of leukemia-free survival （LFS） was 82.2%. Conclusion Non-T-cell depleted HLA-haploidentical PBSCT is safe and feasible for patients with hematological malignancies after myeloablative conditioning regimen combined with intensive immunosuppressants.

关 键 词：造血干细胞移植 HLA抗原 血液肿瘤 移植物抗宿主病 

分 类 号：R686[医药卫生—骨科学]