造血干细胞移植联合中医辨证分型治疗骨髓增生异常综合征的临床观察  

Treatment of Myelodysplastic Syndrome by Hematopoietic Stem Cell Transplantation Combined with Chinese Medical Syndrome Typing:a Clinical Study

作　　者：张宇[1] 叶宝东[1] 钱丽丽[1] 高雁婷[1] 温晓文[2] 沈建平[1] 周郁鸿[1] 

机构地区：[1]浙江省中医院血液科,杭州310006 [2]浙江中医药大学第一临床医学院,杭州310053

出　　处：《中国中西医结合杂志》2015年第1期53-56,共4页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：国家中医临床研究基地业务建设科研专项基金资助项目(No.JDZX2012178);浙江省中医药优秀青年人才基金计划(No.2012ZQ010)

摘　　要：目的探讨造血干细胞移植联合中医药分型治疗骨髓增生异常综合征（MDS）的临床疗效。方法 6例均为2009年7月—2013年7月浙江省中医院血液科同胞相合异基因造血干细胞移植联合中医辨证分型治疗MDS患者。其中难治性贫血（RA）2例,难治性贫血伴环状铁粒幼红细胞（RARS）1例,难治性血细胞减少伴多系发育异常（RCMD）2例,难治性贫血伴原始细胞增多-Ⅰ型（RAEB-Ⅰ）1例。预处理采用改良的Bu Cy方案。移植方式：骨髓移植2例,外周血干细胞移植1例,骨髓联合外周血干细胞移植3例。移植物抗宿主病（GVHD）的预防采用环孢素、短程甲氨喋呤加霉酚酸酯。根据患者国际预后积分系统（IPSS）危险度分为中危5例,高危1例。在移植前后根据中医辨证分型给予不同中药治疗。结果所有患者均顺利造血重建,中性粒细胞≥0.5×109/L和血小板≥20×109/L的中位时间分别为移植后13（9~15）天和11（9~22）天。4例患者发生急性GVHD,其中Ⅰ度3例,Ⅱ度1例;1例患者发生局限型慢性GVHD。中位随访18（11~58）个月,均无病存活。患者总体生存率及无病生存率均为100%。结论中医药参与造血干细胞移植治疗MDS,可改善症状,减轻移植相关并发症,是一种有效的治疗选择。Objective To evaluate the clinical efficacy of treating myelodysplastic syndrome（ MDS） by hematopoietic stem cell transplantation（ HSCT） combined with Chinese medical syndrome typing. Methods From July 2009 to July2013,6 MDS patients were treated with allo-HSCT combined with Chinese medical syndrome typing from HLA-identical sibling donors at Department of Hematology,Zhejiang Provincial Hospital of Chinese Medicine. Patients were classified as refractory anemia（ RA,2 cases）,refractory anemia with ringed sideroblast（ RARS,1 case）,refractory cytopenia with multilineage dysplasia（ RCMD,2 cases）,and RA with excess blasts-Ⅰ（ RAEB-Ⅰ,1 case）. Modified Bu Cy conditioning regimen was used in all 6 cases. Two patients received bone marrow transplantation（ BMT）,1 patient received peripheral blood stem cell transplantation（ PBSCT）,and 3 patients received BMT ＋ PBSCT. In order to prevent the occurrence of graft-versus-host disease（ GVHD）,all patients were treated with cyclosporine ＋ methotrexate ＋ mycophenolate mofetil. Different Chinese medical treatment methods（ by syndrome typing） were given to patients according to different criticality of international prognostic scoring system（ IPSS,5 at moderate risk and 1 at high risk）. Results All 6 patients successfully reconstructed their hematopoietic system. The time from transplantation to ANC≥0. 5 × 109/ L and platelet（ PLT） ≥20 × 109/ L were 13（ 9- 15） days and 11（ 9- 22） days respectively. Main complications were GVHD. Acute GVHD（ a GVHD） occurred in 4cases,3 cases of grade Ⅰ and 1 case of grade Ⅱ,and local chronic GVHD（ c GVHD） occurred in 1 patient. All cases survived with median follow-up of 18（ 11- 58） months. The overall survival（ OS） and disease-free survival（ DFS） rate were100%. Conclusions HSCT combined with Chinese medical syndrome typing could improve clinical symptoms,reduce transplant associated complications. So it was an effective treatment choice for MDS.

关 键 词：骨髓增生异常综合征 造血干细胞移植 中医药 

分 类 号：R551.3[医药卫生—血液循环系统疾病]