国产猪抗人淋巴细胞免疫球蛋白在重型再生障碍性贫血异基因造血干细胞移植中的应用研究  

Application of domestic porcine antihuman lymphocyte immunoglobulin in allogeneic hemopoietic stem cell transplantation for severe aplastic anemia

作　　者：张璞[1] 冯凯[1] 付杰[1] 薛燕[1] 张慈现[1] 向立丽[1] 马家乐 李晓林[1] Zhang Pu;Feng Kai;Fu Jie;Xue Yan;Zhang Cixian;Xiang Lili;Ma Jiale;Li Xiaolin(Department of Hematology,Xuzhou Central Hospital,Jiangsu Xuzhou 221009,China)

机构地区：[1]江苏省徐州市中心医院血液科,221009

出　　处：《中国医师进修杂志》2019年第1期22-25,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨国产猪抗人淋巴细胞免疫球蛋白(p-ALG)在重型再生障碍性贫血(SAA)异基因造血干细胞移植(HSCT)中的疗效。方法回顾性分析2015年1月至2018年5月5例异基因造血干细胞移植的SAA患者的临床资料。预处理方案为p-ALG+环磷酰胺+氟达拉滨;异基因HSCT方式采用外周干细胞+骨髓血(采集骨髓血总量小于400ml,不更换穿刺点)。记录p-ALG相关并发症、移植后造血干细胞重建时间、疗效等。结果发生p-ALG过敏反应1例,无血清病反应。5例患者均获得造血重建,移植后中性粒细胞计数>0.5×10^9/L时间为第11~17天,血小板计数>20×10^9/L时间为第11~15天,短串重复序列聚合酶链反应检测均为完全供者嵌合体。3例出现移植物抗宿主病,给予甲泼尼龙、他克莫司等治疗,均顺利控制。脱离输红细胞悬液时间为第9~87天。随访1~37个月,患者生活状况良好。结论p-ALG应用于SAA异基因HSCT中疗效肯定,费用明显降低,值得推广。ObjectiveTo investigate the efficacy of domestic porcine antihuman lymphocyte immunoglobulin (p-ALG) in the treatment of severe aplastic anemia (SAA) with allogeneic hemopoietic stem cell transplantation (HSCT).MethodsThe clinical data of 5 SAA patients who received allogeneic HSCT from January 2015 to May 2018 were retrospectively analyzed. The conditioning regimen included p-ALG+ cyclophosphamide + fludarabine. The method of peripheral stem cell and bone marrow blood was used in allogeneic HSCT (the total amount of bone marrow blood was less than 400 ml and the puncture point was not replaced). The p-ALG related complications, post-transplantation hemopoietic stem cell reconstitution time and efficacy were recorded.ResultsAllergic reaction occurred in 1 patient when using p-ALG, and there was no serum reaction. Hemopoietic reconstitution was achieved in all the 5 patients. The time for neutrophilic granulocyte > 0.5 × 10^9/L was 11 to 17 d, and the time for platelet count > 20 × 10^9/L was 11 to 15 d after transplantation. The results of short-strand repeat polymerase chain reaction assays showed all complete donor chimera. Graft versus host disease occurred in 3 cases, and was successfully controlled by methylprednisolone and tacrolimus. The time for stopping red blood cell transfusion was 9 to 87 d. The patients were followed up for 1 to 37 months, and the patients all survived well.ConclusionsThe efficacy of p-ALG in SAA patients of allogeneic HSCT is affirmative, and the cost is obviously reduced. It is worthy of clinical use.

关 键 词：贫血 再生障碍性 抗淋巴细胞血清 造血干细胞移植 治疗应用 

分 类 号：R556.5[医药卫生—血液循环系统疾病] R457.7[医药卫生—内科学]