HLA相合同胞供者异基因造血干细胞移植治疗慢性粒细胞白血病40例  

HLA-matched sibling donor allogeneic hematopoietic stem cell transplantation for treatment of chronic myeloid leukemia in 40 cases

作　　者：王兴兵[1] 刘会兰[1] 耿良权[1] 刘欣[1] 杨会志[1] 韩永胜[1] 汤宝林[1] 朱薇波[1] 王祖贻[1] 孙自敏[1] 

机构地区：[1]安徽医科大学附属安徽省立医院血液科,安徽省合肥市230001

出　　处：《中国组织工程研究与临床康复》2009年第14期2618-2622,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：国家自然科学基金资助项目(30700329);安徽省优秀青年科技基金资助项目(08040106810);安徽省自然科学基金资助项目(070413094)~~

摘　　要：背景:异基因造血干细胞移植仍是目前惟一能根治慢性粒细胞白血病的方法。随着移植技术的日臻完善,有HLA相合同胞供者的年轻慢性粒细胞白血病患者只需冒较小的近期风险,便可获得治愈疾病的远期疗效。目的:回顾性分析HLA相合同胞供者异基因造血干细胞移植治疗慢性粒细胞白血病的疗效。设计:回顾性病例分析。对象:选择2002-02/2007-12在安徽省立医院血液科住院接受异基因造血干细胞移植的慢性粒细胞白血病患者40例,男29例,女11例,中位年龄35岁;慢性期30例,加速期5例,急变期5例。供者均为HLA6/6位点配型完全相合的同胞。方法:根据移植方式进行分组:异基因骨髓移植组3例、异基因外周血干细胞移植组8例,联合组29例(异基因外周血干细胞移植+异基因骨髓移植)。预处理方案采用白消安+环磷酰胺或氟达拉滨+环磷酰胺+全身照射2Gy。移植物抗宿主病预防方案为环孢素A+霉酚酸酯。随访中位时间为移植后28个月。主要观察指标:造血功能恢复,移植相关并发症,复发及治疗转归,长期生存情况。结果:40例患者均获造血重建。40例患者中,12例(30%)发生急性移植物抗宿主病,Ⅰ度5例(13%),Ⅱ度6例(15%),Ⅲ度1例(诱发)(3%)。可评估的存活100d以上的39例患者中,15例(39%)出现慢性移植物抗宿主病。与联合组比较,异基因外周血干细胞移植组慢性移植物抗宿主病发生率明显升高(P<0.05)。40例患者中,11例发生Ⅱ度～Ⅲ度迟发性出血性膀胱炎,无急性出血性膀胱炎和肝静脉闭塞病发生。长期无病生存率80%,其中慢性期30例长期无病生存率为87%,5例急变期患者长期无病生存率为20%。加速期5例患者使用伊马替尼达到2次慢性期后进行移植,至今全部无病生存。死亡8例,其中2例死于复发,5例死于移植相关并发症,自杀1例。结论:HLA相合同胞供者异基因造血干细胞移植是治疗慢性粒细胞白血病BACKGROUND： Allogeneic hematopoietic stem ceil transplantation （allo-HSCT） is the only method for treating chronic myelocytic leukemia （CML） presently. With development of transplantation technology, young patients with identical HLA donors may have a little short-term risk to obtain a long-term curative effect for treating disease. OBJECTIVE： To retrospectively analyze the clinical outcome of HLA matched sibling donor alIo-HSCT for CML. DESIGN： Retrospective case analysis. PARTICIPANTS： A total of 40 CML patients （29 males and 11 females） undergoing allo-HSCT, averagely aged 35 years, at the Department of Hematology, Anhui Provincial Hospital, were enrolled from February 2002 to December 2007.30 patients were in chronic phase, 5 in the accelerated phase and 5 in blast phase. Donors were identical to HLA6/6 site. METHODS： Grouping was done according to transplantation method. 3 cases received allogeneic bone marrow transplantation. 8 cases received allogeneic peripheral blood stem cell transplantation. 29 cases received peripheral blood stem cell transplantation combined with bone marrow transplantation （combination group）. Conditioning regimens were BuCy2 protocol or total body irradiation ＋ cyclophosphamJde ＋ fludarabJne protocol. Mycophenolate mofetile and cyclosporin A were used for graft-versus-host disease （GVHD） prophylaxis. The average follow up was 28 months. MAIN OUTCOME MEASURES： The following parameters were measured： recovery of hematopoietic function, transplantation-related complication, relapse, turnover, and long-term survival. RESULTS： All 40 patients were successfully engrafted. Among them, acute GVHD occurred in 12 patients （30%）, grade Ⅰ in 5 cases （13%）, grade Ⅱ in 6 cases （15%）, grade Ⅲ in 1 case （3%）. Chronic GVHD was in 15 among 39 patients （39%）. The incidence rate of chronic GVHD was significantly higher in allogeneic peripheral blood stern cell transplantation group compared with combination group （P 〈 0.05）. Of 40

关 键 词：造血干细胞移植 慢性粒细胞白血病 HLA相合 同胞 

分 类 号：R394.2[医药卫生—医学遗传学]