异基因造血干细胞移植治疗恶性血液病20例临床疗效观察  

Clinical observation of allogeneic hematopoietic stem cell transplantation for 20 patients with hematologic malignancies

作　　者：潘鹏吉[1] 王季石[1] 孙志强[1] 卢英豪[1] 李梦醒[1] 赵鹏[1] 龙正美[1] 

机构地区：[1]贵阳医学院附属医院血液科,550004

出　　处：《白血病．淋巴瘤》2012年第2期77-82,共6页Journal of Leukemia & Lymphoma

基　　金：国家自然科学基金（81070444）;贵阳市科技局基金（T2009-5）;贵州省社会攻关项目（D2011-11）

摘　　要：目的探讨异基因造血干细胞移植（allo—HSCT）治疗恶性血液病的疗效，观察造血重建、移植物抗宿主病（GVHD）发生、移植相关并发症及疾病的转归。方法回顾性分析allo—HSCT治疗恶性血液病患者20例，男15例，女5例，中位年龄39岁（8～59岁）。供者于移植前3d采用重组人粒细胞集落刺激因子（rhG—CSF）行干细胞动员；预处理方案：人类白细胞抗原（HLA）亲缘全相合移植患者采用改良Bu／cy方案；HLA亲缘不全相合耆采用改良Bu／Cy＋ATG方案；急性T淋巴细胞白血病（T—AIJL）和多发性骨髓瘤（MM）患者采用Flu＋Bu／Cy方案。GVHD预防方案：麦考酚酸酯＋环孢素＋短疗程甲氨蝶呤。结果20例患者均成功获得造血重建，中性粒细胞计数〉0．5×10^9／L的中位时间为13d（12～17d），血小板〉20×10^9／L的中位时间为16d（12～23d），且供者CD；4细胞采集量〉2．5X10^6／kg（受者体质量）或单个核细胞采集量〉5．0×10^8／kg（受者体质量）所移植的患者造血重建较快。12例供受者血型不合，移植后未出现严重溶血反应；11例（55％）发生急性GVHD（aGVHD），包括Ⅰ度4例，Ⅱ度4例，Ⅲ度2例，Ⅳ度1例，均经治疗后好转。移植后所有患者均达到完全缓解（CR），中位随访6个月（2～14个月），1例白血病患者移植后5个月复发死亡，1例移植后4个月因自行停用环孢素发生自身免疫性溶血、慢性GVHD（cGVHD）、多器官衰竭死亡，其余患者仍处于CR状态。结论allo—HSCT是治疗恶性血液病的有效方法。造血重建与采集物中造血干细胞的数量密切相关。ABO血型不合不是移植的障碍。复发、GVHD、感染是移植后死亡的重要原因。Objective To evaluate the efficacy of allogeneic stem cell transplantation （allo-HSCT） in treatment of hematologic malignancies and observe hcmatopoietic reconstitution, graft versus host disease （GVHD） occurrence, transplant-related complications and the outcome of disease. Methods 20 patients with hematologic malignancies cured by allo-HSCT were analyzed retrospectively. 15 males and 5 females patients were enrolled, and the median age was 39 （8-59） years. Mobilization of donor＇ s stem cells using rhG-CSF program 3 days before transplantation. Conditioning regimen： the patients with HLA-matched used modified Bu/Cy programs, the patients with HLA-mismatched （with 1 to 3 loci mismatched） used the modified Bu/Cy＋ ATG program; the patient with T-ALL and the patient with MM used Flu＋Bu/Cy program. GVHD prevention programs： mycophenolate mofetil ＋ cyclosporine ＋ short course methotrexate. Results 20 patients were successfully engrafted, the median time of absolute neutrophil count （ANC） 〉 0.5×10^9/L was 13 （12-17） days, the median time of Ph 〉 20×10^9/L was 16 （12-23） days, and the hematopoietic reconstitution was rapid in those patients who were transplanted by the donors with the collected amount of CD34^＋ ceils 〉 2.5× 10^6/kg （recipient body weigh） or the collected amount of mononuclear cell 〉 5.0×10^8/kg （recipient body weigh）. No severe hemolytic reaction occun＇ed in 11 cases of blood group incompatibility between donor and recipient after transplantation, 11 cases （55 %） developed acute GVHD （aGVHD）： 4 cases I degree aGVHD, 4 cases Ⅱ degree aGVHD, 2 cases Ⅲ degree aGVHD, 1 case Ⅳ degree aGVHD, all patients were improved after treatment. All patients attained complete remission （CR） after transplantation. Follow-up 6 （2-14） months,1 patient died in 5 months after transplantation because of leukemia relapse, l case died in 4 months after transplantation because of self-disabling autoimmune hemolytic cyclosporine, chronic GVH

关 键 词：血液肿瘤 造血干细胞移植 异基因 移植物抗宿主病 ABO血型不合 复发 造血重建 

分 类 号：R733[医药卫生—肿瘤]