HLA半相合异基因外周血造血干细胞移植治疗AA克隆演变继发MDS疗效分析  被引量:3

Efficiency and safty of haploidentical hematopoietic stem cell transplantation for myelodysplastic syndrome evolved from aplastic anemia

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作  者:黄菲[1] 张闰[1] 缪扣荣[1] 吴汉新[1] 沈文怡[1] 陆化[1] Huang Fei, Zhang Run, Miao Kourong, Wu Hanxin, Shen Wenyi, Lu Hua(Department of Hematology, the First Affiliated Hospital of NMU , Nanjing 210029, China)

机构地区:[1]南京医科大学第一附属医院血液科,江苏南京210029

出  处:《南京医科大学学报(自然科学版)》2018年第9期1269-1274,共6页Journal of Nanjing Medical University(Natural Sciences)

基  金:国家自然科学基金青年基金(81400079);江苏省卫计委项目(Z201402);江苏省科教强卫工程医学青年人才(QNRC2016565);江苏省六大人才高峰(WSN-026)

摘  要:目的:回顾性分析应用HLA半相合异基因外周血造血干细胞移植(haploidentical hematopoietic stem cell transplantation,haplo-HSCT)治疗再生障碍性贫血(aplastic anemia,AA)克隆演变继发骨髓增生异常综合征(secondary myelodysplastic syndrome,s MDS)的疗效和安全性。方法:本中心5例AA患者经强化免疫抑制治疗后演变为s MDS,均采用haplo-HSCT,观察植入情况,移植物抗宿主病(graft versus host disease,GVHD)、移植相关并发症和移植相关病死率(transplant related modify,TRM)、总体生存(overall survival,OS)时间等。结果:5例中位OS时间63个月(41.9~149.3个月),移植后中位OS时间12.9个月(2.4~36.5个月),1年累积生存率60%,TRM 40%。移植后粒系植入时间18 d(14~22 d),血小板植入时间21 d(15~65 d),总植入率100%。60%(3/5)患者发生Ⅰ~Ⅲ度急性移植物抗宿主病(acute graft versus host disease,a GVHD),无Ⅳ度a GVHD发生,20%(1/5)患者发生慢性移植物抗宿主病(chronic graft versus host disease,c GVHD)。中位随访时间63个月(41.9~149.3个月)。结论:在无合适HLA相合供者情况下,haplo-HSCT可作为AA演变MDS患者的有效治疗策略。Objective:To evaluate the efficiency and safety of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) for treatment of secondary myelodysplastic syndrome (sMDS) after AA. Methods: Evaluation of therapeutic effect, incidence rate of aGVHD and cGVHD, complications and overall survival (OS) of 5 AA post MDS patients who received haplo-HSCT in this center, and compared with other treatments for sMDS evolved from AA. Results:Among 5 patients, median OS was 63 months (range from 41.9 to 149.3 months), OS after HSCT was 12.9 months (range from 2.4 to 36.5 months). 1-year event free survival was 60%. All patients achieved neutrophil and platelet engraftment at a median of 18 days(range from 14 to 22 days)and 21 days(range from 15 to 65 days) respectively. 3 occurred Ⅰ-Ⅲ° acute graft versus host disease (aGVHD), and 1 with chronic graft versus host disease (cGVHD). Medial follow-up was 63 months(range from 41.9 to 149.3 months). Conclusion:The haplo-HSCT can be an opition for sMDS from AA patients in case of an HLA-identical donor is not available.

关 键 词:再生障碍性贫血 克隆演变 骨髓增生异常综合征 HLA半相合异基因外周血造血干细胞移植 

分 类 号:R556.5[医药卫生—血液循环系统疾病]

 

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