骨髓联合外周血单倍体相合造血干细胞移植治疗白血病  

Haploidentical Allogeneic Bone Marrow Stem Cell Transplantation Combined with Peripheral Blood Stem Cells for Therapy of Leukemia

作　　者：闫洪敏[1] 薛梅[1] 王志东[1] 朱玲[1] 刘静[1] 丁丽[1] 潘世平[1] 段连宁[1] 王恒湘[1] 

机构地区：[1]空军总医院血液科全军单倍体相合骨髓移植中心,北京100036

出　　处：《中国实验血液学杂志》2009年第5期1330-1334,共5页Journal of Experimental Hematology

摘　　要：本研究探讨(G-CSF)动员骨髓加外周血联合进行单倍体相合造血干细胞移植(hiBM+PBSCT)治疗白血病的可行性及疗效。125例白血病患者接受了单倍体相合未去T细胞的造血干细胞移植。所有供者应用G-CSF5μg/(kg.d),皮下注射,连用7天。实验组(A组)29例患者在供者动员的第7、8天分别接受1次hiBMT+PBSCT移植;对照组(B组)96例仅接受1次单倍体相合骨髓造血干细胞移植(hiBMT)。对两组患者应用相同的免疫抑制剂预防急性GVHD,观察临床的移植效果。结果表明:除hiBMT组有1例慢性髓系白血病合并骨髓纤维化患者移植失败外,其余全部患者移植后经检测证实为完全供者造血,hiBM+PBSCT组和hiBMT组中性粒细胞数>0.5×109/L的中位时间分别为15(10-23)天和19(11-26)天;血小板数>20×109/L时间分别为18(9-33)天和23(13-35)天。hiBM+PBSCT组和hiBMT组急性Ⅱ-Ⅳ度aGVHD的累计发生率分别是31.03%和12.5%,二者差异有显著性意义(p<0.05),但急性Ⅲ-Ⅳ度aGVHD的发生率分别是13.79%和10.41%(p>0.05)、aGVHD相关死亡率分别为3.45%和5.21%(p>0.05),差异均无显著性意义。骨髓联合外周血移植组和单纯骨髓移植组慢性GVHD的累计发生率分别是48.2%和35.4%(p>0.05),二者差异无显著性意义。广泛型慢性GVHD发生率两组分别为23.3%和15.6%(p>0.05),差异无显著性意义。骨髓联合外周血移植组和单纯骨髓移植组疾病复发率分别是6.8%(2/29)和18.7%(18/96)(p<0.05),二者差异有显著性意义。结论:G-CSF动员骨髓联合外周血单倍体相合造血干细胞移植后造血重建更快,急性Ⅲ-Ⅳ度GVHD发生率和死亡率无明显增加,高危白血病的复发率下降,可以有效安全应用于临床。The purpose of this study was to investigate the feasibility and clinical outcome of granulocyte colony stimulating factor （G-CSF）-mobilized haploidentical bone marrow transplantation combined with peripheral blood stem cells （hiBM ＋ PBSCT） for therapy of leukemia. 125 leukemia patients underwent G-CSF primed haploidentical stem cell transplantation without ex-vivo T cell depletion. All haploidentical donors were injected with G-CSF at dose of 5μg/（ kg· d） for 7 days. The patients were divided into groups A and B, 29 patients in group A underwent hiBM ＋ PBSCT at 7th and 8th days of mobilzation in donors with G-CSF respectively; 96 patients in group B underwent hiBMT. All patients received the same GVHD prophylaxis regimen, the clinical outcomes were investigated. The results showed that all patients except one CML-myelofibrosis patient achieved trilineage engraftment. Engraftment median times were 15 and 19 days for neutrophil and platelet in group A respectively, while engraftment median times were 18 and 23 days for neutrophil and platelet in group B respectively. The incidences of grade II - IV aGVHD were 31.03% in group A and 12.5% in group B respectively （p 〈 0.05 ）. The incidences of grade III - IV aGVHD was 13.79% and 10.41% in group A and group B （p 〉 0.05 ）. The aGVHD-related death incidence was 3.45% and 5.21% in group A and group B （p 〉0.05）. The incidence of grade II - IV cGVHD was 48.2% and 35.4% in group A and group B respectively （p 〉 0.05 ）. The incidence of extensive cGVHD was 23.3 % and 15.6 % in group A and group B respectively （p 〉 0.05 ）. The disease relapse rate was 6.8% （2/29） and 18.75% （18/96） in group A and group B respectively （p 〈0.05）. It is concluded that the G-CSF-mobilized allogeneic haploidentical BM plus peripheral blood HSCT without T cell depletion provides a rapid and sustained engraftment without increase of severe GVHD, furthermore, the relapse rate of disease is reduced remarkably, thus this method can be used in

关 键 词：造血干细胞移植 白血病 单倍体相合骨髓移植 移植物抗宿主病 

分 类 号：R457.7[医药卫生—治疗学]