HLA半相合未去除T细胞骨髓移植治疗白血病的初步观察  

Preliminary study of HLA haplotype matched and T-cell undepleted allogeneic bone marrow transplantation for treatment of leukemia

作　　者：纪树荃[1] 陈惠仁[1] 王恒湘[1] 贾晔辉[1] 阎洪敏[1] 刘静[1] 朱玲[1] 薛梅[1] 周琳丽[1] 潘世平[1] 肖名华[1] 

机构地区：[1]解放军空军总医院血液病研究中心,北京100036

出　　处：《中华血液学杂志》2001年第8期408-410,共3页Chinese Journal of Hematology

摘　　要：目的　探索半相合未去除T细胞骨髓移植治疗白血病的可行性。方法　 15例白血病患者接受HLA 2～ 3个位点不匹配亲缘骨髓移植。用阿糖胞苷、环磷酰胺和γ射线全身照射进行预处理 ,供者应用G CSF 2 5 0 μg/d ,连用 7d后采髓 ,移植物抗宿主病 (GVHD)预防除用环孢菌素A(CsA)和甲氨蝶呤 (MTX)外 ,在移植前第 4天～第 1天用抗胸腺细胞球蛋白ATG 5mg·kg-1·d-1,移植后第 7天开始加用霉酚酸酯 1.0g/d。结果　患者移植后均获得造血重建 ,中性粒细胞 >0 .5× 10 9/L和血小板 >2 0× 10 9/L的中位时间分别是 19d(13～ 2 3d)和 2 1d(16～ 32d)。 5例 (33.3% )发生急性Ⅱ～Ⅳ度GVHD ,其中急性Ⅱ度肠道GVHD 2例 ,急性Ⅲ度肠道GVHD 2例 ,急性肠道和肝脏Ⅳ度GVHD 1例。可评价的9例患者中 8例发生慢性GVHD ,无一例发生广泛性慢性GVHD。中位随访时间 395d(110～ 6 90d) ,死亡 6例 ,其中死于急性GVHD 3例 ,死于感染 2例 ,复发死亡 1例。无病存活 9例 ,其中 6例存活在 1年以上。结论　供者应用G CSF后采髓 ,多种免疫抑制剂联合应用的HLA半相合未去除T细胞骨髓移植 ,在治疗白血病过程中 ,有效地降低了急性重症GVHD发生 ,提高了无病生存 。Objective To explore the feasibility of allogeneic bone marrow transplantation (Allo BMT) with graft from HLA haplotype matched related donor without T cell depleted for the treatment of leukemia. Methods Fifteen patients with leukemia received allo BMT with grafts from HLA 2 or 3 antigen mismatched related donors. All patients were treated with standardized conditioning regimen consisting of high dose Ara C,cyclophosphamide(CY) and total body irradiation (TBI). Donors were given G CSF at 3 to 4 μg·kg -1 ·d -1 for seven days prior to marrow harvest. GVHD prophylaxis programme consisted of CsA, MTX,ATG and mycophenolate mofetial. Results All patients established successful engraftment. The median days of granulocyte >0.5×10 9/L and platelet >20×10 9/L were 19(range 13～23) and 21 (range 16～32) days, respectively. Acute grade Ⅱ～Ⅳ GVHD occurred in 5 of 15 patients (33.3%). Two of them were grade Ⅱ gut aGVHD, 2 grade Ⅲ gut aGVHD, and 1 grade Ⅳ gut and liver aGVHD. Chronic GVHDs were seen in 8 of 9 evaluable patients (88.9%) and none developed extensive cGVHD. The median follow up duration was 395 (110～690) days. Six of fifteen patients died. Five of them died from transplantation related mortality and 1 from relapse. Nine patients were alive in a disease free situation. Six of them survived more than one year. Conclusion The major histoincompatibility barriers in the haplotype matched related donor/ recipient allo BMT might be crossed by donor stimulated with G CSF and combined GVHD prophylaxis program.

关 键 词：异基因骨髓移植 白血病 组织相容性抗原 治疗 

分 类 号：R733.7[医药卫生—肿瘤] R457.7[医药卫生—临床医学]