无关供者造血干细胞移植治疗重型再生障碍性贫血29例的疗效分析  

Outcome of unrelated-donor allogeneic hematopoietic cell transplantation for 29 recipients with severe aplastic anemia

作　　者：周健[1] 张龚莉 符粤文[1] 林全德[1] 梁利杰[1] 喻凤宽[1] 王倩[1] 韩利杰[1] 祖璎玲[1] 房佰俊[1] 魏旭东[1] 宋永平[1] 

机构地区：[1]郑州大学附属肿瘤医院河南省肿瘤医院血液科河南省血液病研究所,450003

出　　处：《中华器官移植杂志》2017年第2期78-83,共6页Chinese Journal of Organ Transplantation

摘　　要：目的 评估无关供者异基因造血干细胞移植（URD allo-HSCT）治疗重型再生障碍性贫血（SAA）的效果,及其与HLA全相合同胞供者allo-HSCT（MSD allo-HSCT）的差异.方法 根据供者来源不同,将2001年10月至2016年12月64例接受alb-HSCT治疗的SAA患者分为无关供者组（URD组,29例）和全相合同胞供者组（MSD组,35例）.比较两组受者的移植效果及相关并发症发生情况.结果 URD组与MSD组移植后造血功能重建情况,排斥反应发生率的差异均无统计学意义（P均＞0.05）.URD组Ⅱ～Ⅳ度急性移植物抗宿主病（GVHD）和慢性GVHD的发生率明显高于MSD组（30.76％与8.57％,P=0.026;26.92％和5.71％,P=0.021）.两组受者移植后肺部感染、巨细胞病毒血症、EB病毒血症和出血性膀胱炎的发生率相似.MSD组与URD组受者预计5年总体存活率（OS）分别为（73.6±8.7）％和（72.7±9.5）％（P=0.878）,预计5年无SAA复发存活率（DFS）分别为（73.6±8.7％）％和（70.3±10.2） ％（P=0.668）.结论 URD allo-HSCT治疗SAA的疗效与MSD allo-HSCT相当,在无HLA全相合同胞供者时可作为SAA患者的一线治疗选择.Objective To assess the effectiveness of unrelated donor （URD） allogeneic hematopoietic stem cell transplantation （allo-HSCT） in the treatment of severe aplastic anemia （SAA）,and the difference between URD allo-HSCT and matched sibling donor （MSD） allo-HSCT.Methods According to the source of donors,the SAA patients subject to allo-HSCT were divided into MSD allo-HSCT group （MSD group） and URD allo-HSCT group （URD group） from October 2001 to December 2016 in Henan Cancer Hospital.The efficacy and transplantation related complications were compared between two groups.Results There were no statistically significant differences in hematopoietic reconstitution and graft rejection between two groups.The incidence of grade Ⅱ-Ⅳ acute GVHD and chronic GVHD was higher in the URD group than in the MSD group （30.76% vs.8.57%,P =0.026;26.92% vs.5.71%,P =0.021）.However,other transplant-related complications including pulmonary complications and hemorrhagic cystitis,incidence of EBV and CMV reactivation and venous occlusive disease showed no significant difference between two groups.The estimated 5-year over survival was （73.6 ± 8.7） % in the MSD group and （72.7 ± 9.5） % in the URD group （P =0.878）.There was no significant difference in 5-year disease-free survival between two groups （73.6 ± 8.7% vs.70.3 ± 10.2,P =0.668）.Conclusion URD-HSCT is a novel treatment approach and could be considered as first-line therapy in selected patients without MSD.

关 键 词：再生障碍性贫血 造血干细胞移植 无关供者 同胞供者 

分 类 号：R457.7[医药卫生—治疗学]