异基因造血干细胞移植后淋巴细胞增殖性疾病临床观察  

Clinical observation of post-transplant lymphoproliferative disease treated with allogeneic hemapoietic stem cell transplantation

作　　者：符祥俊[1] 姚红霞[1] 吴从明[1] 陈文婷[1] 史鹏程[2] 

机构地区：[1]海南省人民医院血液科,海南海口570311 [2]南方医科大学南方医院血液科,广东广州510515

出　　处：《中国热带医学》2013年第9期1124-1126,共3页China Tropical Medicine

基　　金：国家自然科学基金地区科学基金项目(No.30960364)

摘　　要：目的观察异基因造血干细胞移植(allo-HSCT)后淋巴细胞增殖性疾病(PTLD)的临床特征、治疗及转归。方法 9例(4例急性淋巴细胞白血病,2例淋巴瘤,2例再生障碍性贫血和1例急性髓系白血病)患者行allo-HSCT。预处理方案包括:4例全身放疗(TBI)+环磷酰胺(CY)+依托泊苷(VP-16)、1例氟达拉滨(Flu)+阿糖胞苷(Ara-c)+TBI+CY、1例氟达拉滨(Flu)+阿糖胞苷(Ara-c)+TBI+VP-16、2例Flu+CY、1例TBI+CY。以环孢素A(CSA)、霉酚酸酯(MMF)、抗淋巴细胞球蛋白(ATG)加短程甲氨蝶呤(MTX)预防aGVHD。结果 9例患者发生PTLD的中位时间为移植后60(42-510)天,8例伴前驱EB病毒感染,4例出现PTLD中枢侵犯。经美罗华外周静脉注入及鞘内注射治疗,7例患者病情得以控制,2例死亡,治疗总有效率为77.7%。结论 PTLD是allo-HSCT后少见的最严重并发症之一,美罗华外周静脉注入及鞘内注射治疗PTLD合并中枢侵犯效果明显,为一线治疗方案。Objective To investigate the clinical characteristics, treatment and outcome of lymphoproliferative disease （PTLD） treated with allogeneic hemapoietic stem cell transplantation （allo-HSCT）. Methods Nine patients（4 with acute lymphocytic leukemia,2 with severe aplastic anemia, 2 with lymphadenoma, and 1 with acute myelocytic leukemia） underwent allo-HSCT. The conditioning regimens included TBI （total body irradiation） ＋CY （cyclophosphanfide） ＋VP-16 （etopeside）（n= 4）, Flu （fludarabine） ＋Ara-C （cytarabine）＋TBI＋CY （n=l）, Flu＋Ara-C ＋TBI＋VP-16（n=1）, Flu＋CY（n=2） and TBI＋CY （n=1）. The prevention of aGVHD included cyclosporine A, mycophenolate mofetil, anti-thymoeyte globulin and short course methotrexate. Results The median time of PTLD development was 60（42-510）days after allo-HSCT.Eight patients appeared prodromic Epstein-Barr virus infection,and four patients developed centra nervous system（CNL） infringement;Seven patients achieved complete remission and two patients died after the treatmen of Rituximab administered Intravenous drip and Intrathecal injection;The overall effective rate was 77.7%.Conclusion PTLD is one of the most rare severe complications after allo-HSCT.The treatment of Rituximab administered intravenous drip and Intrathecal injection is safe and efficient in patients with CNL-PTLD ,which could be recommended as the first-line therapy.

关 键 词：移植后淋巴细胞增值性疾病 PTLD中枢侵犯 利妥昔单抗 EB病毒 异基因造血干细胞移植 

分 类 号：R733.7[医药卫生—肿瘤]