150例异基因造血干细胞移植治疗恶性血液病的疗效分析  

Curative effect analysis of allogeneic hematopoietic stem cell transplantation for 150 patients with hematological malignancies

作　　者：卢英豪[1] 王季石[1] 张燕[1] 赵鹏[1] 徐吉兵[2] 

机构地区：[1]贵州医科大学附属医院血液科/贵州省造血干细胞移植中心,贵阳550004 [2]贵州省安顺市人民医院血液科,561000

出　　处：《重庆医学》2016年第2期148-150,155,共4页Chongqing medicine

基　　金：国家自然科学基金资助项目(81070444;81270636);贵阳市科技局筑科合同(筑科合同[20141001]47号)

摘　　要：目的分析异基因造血干细胞移植（allo—HSCT）治疗恶性血液病的疗效及安全性，探讨移植相关并发症及影响预后的因素。方法回顾性分析2010年6月至2015年6月贵州医科大学附属医院造血干细胞移植中心行allo-HSCT的150例恶性血液病患儿的病历资料。按照供者类型不同，将其分为同胞全相舍移植组（n=52）和单倍体移植组（n=98）。所有患者均采用改良白消安／环磷酰胺（BU／CY）为预处理方案，单倍体移植组加用兔抗人胸腺细胞免疫球蛋白（ATG），移植物抗宿主病（GVHD）的预防采用短疗程甲氨蝶呤＋环孢素A＋吗替麦考酚酯，对150例患者疗效、安全性及移植相关并发症进行分析。结果150例患者经血型、染色体或DNA多态性检测证实均达到完全供者细胞植入，同胞全相合移植组平均中性粒细胞及血小板重建时间为移植后12d和16d，单倍体移植组平均中性粒细胞及血小板重建时间为移植后13d和16d。150例患者中，59例（39．3％）患者出现口腔黏膜溃疡，47例（31.3%）患者移植后100d内发生细菌和（或）真菌感染，41例（27．3％）患者移植后100d内发生巨细胞病毒感染，48例（32．0％）患者发生急性GVHD，43例（28．7％）患者发生慢性GVHD。随访1～60个月，中位随访时间23个月。115例（76．7％）患者无病存活，其中同胞全相合移植组38例（73．1％，38／52），单倍体移植组77例（78．6％，77／98）。35例（23．3％，35／150）患者死亡，其中同胞全相合移植组死亡14例（26．9％，14／52），单倍体移植组死亡21例（21．4％，21／98）。死因分析发现，12例（8．0％）因移植相关并发症死亡，其中5例（3．3％）因严重感染，7例（4．7％）因急性GVHD；23例（15．3％）患者因原发病复发死亡。两组患者生存率及死亡率比较差异无统计学意义（P〉0．05）。结论allo-HSCT治疗恶性血液Objective To evaluate the efficacy and safety and to analyze related complications and potential prognostic factors of allogeneic hematopoietic stem cell transplantation（allo-HSCT） on hematological malignancies. Methods Patients with hematological malignancies who underwent allo-HSCT from June 2010 to June 2015 were investigated in this retrospective study. According to the donor types,it was divided into compatriots sibling-matched transplantation group （n= 52） and haploid transplantation group （n= 98）. The preconditioning regimens were busulfan/cyelophosphamide, and anti-thymoeyte globulin were needed in haploid transplantation group. Short-term methotrexate -- eyclosporine A ＋ mycophenolate mofetil were used for prevention of graft-versus-host disease. The efficacy and safety and related complications of allo-HSCT were analyzed. Results All patients achieved full donor type engraftment,which was identified by blood type,chromosome test and DNA polymorphism. The mean times of neutrophil and platetet engraftment were 12 d and 16 d in compatriots sibling-matched transplantation group and 13 d and 16 d in haploid transplantation group, respectively. 59 cases （39.3 %） patients were oral mucosa ulcer, 47 patients （31.3 %） were bacteria and/or fungal infection,41 cases （27.3 %） patients were CMV infection, 48 cases （32.0 %） were acute GVHD,43 patients （28.7 %） were chronic GVHD. The median follow-up time of 23 months （1- 60 months）, 115 patients （76.7 %, 115/150） were disease-free survival, including 38 cases （73. 1%, 38/52） in compatriots sibling-matched transplantation group, 77 cases （78.6%, 77/98） in haploid transplantation group;35 cases （23. 3% ,35/150） patients were died, including 14 cases （26.9%, 14/52） in compatriots sibling- matched transplantation group, 21 cases （21.4 %, 21/98） in haploid transplantation group. Death cause analysis showed that 12 cases （8.0%） complications from transplantation related death,of which 5 cases （3.3%） were

关 键 词：造血干细胞移植 血液肿瘤 手术后并发症 治疗结果 

分 类 号：R457.7[医药卫生—治疗学]