免疫抑制联合脐血输注治疗重型再生障碍性贫血  

Immunosuppressive therapy combined with cord blood infusion in treatment of severe aplastic anemia

作　　者：邵珊 蔡宇[1] 万理萍[1] 杨隽[1] 王椿[1] 姜杰玲[1] SHAO Shan;CAI Yu;WAN Liping;YANG Jun;WANG Chun;JIANG Jieling(Department of Hematology,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,Chin)

机构地区：[1]上海交通大学附属第一人民医院血液科,上海200080

出　　处：《内科理论与实践》2018年第2期81-86,共6页Journal of Internal Medicine Concepts & Practice

摘　　要：目的 :评价采用免疫抑制联合脐血输注治疗重型再生障碍性贫血(severe aplastic anemia,SAA)的疗效。方法:分析2010年5月至2016年5月间我院收治的19例接受氟达拉滨、兔抗胸腺细胞球蛋白(anti-thymocyte globulin,ATG)和环孢素(cyclosporin A,Cs A)免疫抑制并联合脐带血输注患者的临床资料,统计造血恢复情况、治疗反应、治疗相关死亡率、总生存(overall survival,OS)率等。结果:中性粒细胞恢复的中位时间仅为22(13,36)d,血小板恢复的中位时间为180(48,217)d。6例患者有短暂性或持续性脐带血植入,有脐带血植入患者中位血小板恢复时间显著快于无脐带血植入的患者(46 d比206 d,P=0.006)。3个月内治疗相关死亡率仅为5.3%,12个月的累积反应率为88.7%±7.5%,其中完全缓解(complete remission,CR)率达72.2%±10.6%。预期2年和5年OS率分别为94.7%±5.1%和78.9%±15.0%。结论:免疫抑制联合脐血输注治疗SAA安全有效,脐带血输注可能加速免疫抑制治疗SAA患者的造血恢复,有助于降低早期死亡率,增加CR率,保证患者较高的OS率和良好的生活质量。Objective To evaluate whether unrelated cord blood infusion could accelerate the hematopoietic recovery of severe aplastic anemia（SAA） in patients treated by immunosuppressive therapy of rabbit anti-thymocyte globulin（ATG）,fludarabine and cyclosporin A（CsA）. Methods Between May 2010 and May 2016, nineteen patients with SAA were enrolled and treated with rabbit ATG, fludarabine and CsA followed by infusion of one or two units of cord blood. The median time to neutrophil and platelet recovery, the response rate, the incidence of treatment related mortality and overall survival（OS） were analyzed. Results The median neutrophil recovery time was 22（13, 36） d and median platelet recovery time was 180（48, 217） d. Six patients had transient or sustained cord blood engraftment, and the median platelet recovery time was significant faster in patients with cord blood engraftment than those without（46 d vs 206 d, P=0.006）. The treatment related mortality within 3 months was only 5.3%, and the cumulative incidence of response rate at 12 months was88.7%±7.5% with a complete remission（CR） rate of 72.2%±10.6%. The OS at 2 years and 5 years were 94.7%±5.1% and78.9%±15.0%, respectively. Conclusions The results suggested the feasibility and effectiveness of cord blood infusion following intensive immunosuppressive therapy with rabbit ATG, fludarabine and CsA for the treatment of SAA patients. Cord blood infusion may accelerate hematopoietic recovery and contribute to the decrease of early mortality and increase of complete remission rate for achieving a higher overall survival and quality of life.

关 键 词：免疫抑制治疗 脐带血输注 重型再生障碍性贫血 

分 类 号：R556[医药卫生—血液循环系统疾病]