改良BU/CY预处理方案行同胞相合异基因外周造血干细胞移植治疗骨髓增生异常综合征  

Allogeneic peripheral blood stem cell transplantation from HLA identical sibling donor in the treatment of patients with myelodysplastic syndrome with modified BU/CY condition regimen

作　　者：张颢[1,2] 陶艳玲[1,2] 王志国[1,2] 陈波[1,2] 杨在亮[3] 邱林[1,2] 展昭民[1,2] 张伯龙[1,2] 马军[1,2] 

机构地区：[1]黑龙江省哈尔滨市第一医院 [2]哈尔滨血液病肿瘤研究所,150010 [3]第三军医大学大坪医院野战外科研究所/创伤烧伤复合伤国家重点实验室,重庆400042

出　　处：《重庆医学》2012年第35期3697-3698,3701,共3页Chongqing medicine

基　　金：黑龙江省卫生厅科研课题(2011-518);哈尔滨市科技创新人才研究专项基金资助项目(2009RFQQS027)

摘　　要：目的探讨改良BU/CY预处理方案行同胞相合异基因外周血造血干细胞移植(allo-PBSCT)治疗骨髓增生异常综合征(MDS)的疗效。方法收集2009年1月至2010年12月,哈尔滨血液病肿瘤研究所5例MDS进行allo-PBSCT患者。预处理方案为改良BU/CY;预防移植物抗宿主病(GVHD)采用环孢素A/甲氨蝶呤/吗替麦考酚酯(CSA/MTX/MMF)。结果 5例患者均获得移植,中性粒细胞(ANC)≥0.5×109/L的中位时间移植后12.4d(9～14d),血小板(PLT)≥20×109/L中位时间移植后13.25d(10～23d),2例出现Ⅱ度急性移植物抗宿主病(aGHVD),2例出现局限型慢性移植物抗宿主病(cGVHD),3例发生Ⅱ度口腔溃疡,发热4例,其中1例败血症,1例合并肺部感染;2例发生巨细胞病毒(CMV)血症,出血性膀胱炎(HC)2例,1例出现纯红再生性障碍性贫血;中位随访时间12.8个月(8～22个月),1例骨髓增生异常综合征-环形铁粒幼性难治性贫血(MDS-RAS)移植后7个月复发后合并肺部感染死亡,无病存活4例。结论改良BU/CY方案用于MDS移植预处理疗效较好,不良反应可以耐受,安全性好。Objective To assess the clinical efficacy and complications of HLA identical sibling allogeneic peripheral blood stem cell transplantation for myelodysplastic syndrome with modified BU/CY condition regimen.Methods From January 2009 to December 2010,5 patients with myelodysplastic syndrome received HLA identical sibling allo PBSCT in our hospital.Conditioning regimen was modified busulphan cyclophosphamide.Mycophenolate mofetil（MMF）in combination with cyclosporine（CSA）and methotrexate was used to prevent Graft versus host disease（GVHD）.Results Hematopoietic reconstitution was observed in all patients.The time to form transplantation to neutrophil count ≥0.5×109/L and platelet ≥20×109/L were 12.4 d（range：9-14）and 13.25 d（range：10-23）after transplantation respectively.There were 2 cases of aGVHD（Ⅱ）,2 cases of limetd cGVHD,3 cases of oral ulcer,4 cases of fever including 1 patient with septicemia and 1 pulmonary infection.The other complications included 2 cases of cytomegalovirus（CMV）infections,2 hemorrhagic cystitis（HC） and 1 pure red aplastic anemia.After a follow up of median 12.8（8-22） months,4 patients remained survival,and 1 case with MDS RAS resulted in relapse and died of pulmonary infectin on 7 months after transplantation.Conclusion Modified BU/CY madministration can be employed as a preparative regimen for allogeneic HSCT and shows efficacy and transplant adverse effects can be tolerated.HLA identical sibling allo PBSCT in the treatment of patients with myelodysplastic syndrome is safe and efficient.

关 键 词：骨髓增生异常综合征 HLA相合同胞 异基因外周血造血干细胞移植 改良UB CY 

分 类 号：R551.3[医药卫生—血液循环系统疾病]