G-CSF预处理供者单倍体相合骨髓移植加用CD25单克隆抗体预防急性GVHD的临床研究  

A Clinical Study of Haploidentical and G-CSF Primed Bone Marrow Transplantation by Using CD25 for aGVHD Prophylaxis

作　　者：纪树荃[1] 陈惠仁[1] 王恒湘[1] 阎洪敏[1] 刘静[1] 薛梅[1] 朱玲[1] 

机构地区：[1]解放军空军总医院血液科,北京100036

出　　处：《中国实验血液学杂志》2002年第5期447-451,共5页Journal of Experimental Hematology

摘　　要：探索单倍体相合未去T细胞骨髓移植应用CD2 5单克隆抗体预防急性移植物抗宿主病 (GVHD)的疗效。在 1 999年 2月至 2 0 0 1年 1 1月期间 ,对 2 8例白血病病人进行HLA 2 - 3个位点不合骨髓移植 ,其中 2 0 0 0年 1 1月前完成的不使用CD2 5单抗的 1 5例为对照组 ,此后完成的 1 3例为本方案组 ,两组供者均接受粒细胞集落刺激因子(G CSF ,Lenograstim) 2 50 μg/d ,皮下注射 ,连用 7天后采髓 ;环孢菌素A ,氨甲蝶呤 ,抗胸腺细胞球蛋白和霉酚酸酯(MMF)联合用于GVHD预防。研究组病例在移植前 2小时和移植后第 4天加用CD2 5单克隆抗体 (Basiliximab)进一步预防GVHD ;并对两组移植后植入 ,GVHD发生和无病存活情况进行比较。结果表明 ,2 8例患者移植后均植入成功 ,植入直接证据的检测证实完全供者造血 ,两组造血重建时间比较无显著性差异 (P >0 .0 5) ;未用抗体的对照组急性Ⅱ -Ⅳ度GVHD发生率 33 .3 % ,本方案组加用CD2 5单克隆抗体 ,无 1例发生急性Ⅱ -Ⅳ度GVHD ,两组之间差异有显著性 (P <0 .0 5) ;慢性GVHD发生均为局限性 ,两组的差异无显著性 (P >0 .0 5)。对照组中位随访2 6(1 5 - 36)月 ,活存 9/ 1 5例 ,本方案组中位随访 8(3 - 1 5)月 ,活存 1 2 / 1 3例 ,Kaplan Meier存活曲线分析与对数秩检验 ,本方案组 1?To explore the feasibility of using CD25 monoclonal antibody (Basiliximab) in T cell undepleted allo BMT with graft from haplotype matched related donor for acute GVHD prophylaxis. Twenty eight patients with leukemia received allo BMT from HLA two or three loci mismatched related donors. The donors were given G CSF (Lenograstim) 250 μg/d for 7 doses prior to marrow harvest. CSA, MTX, ATG and mycophenolate mofetil (MMF) were combined for GVHD prophylaxis. ATG 5 mg/(kg·d) was infused from day 4 to day 1 before transplantation and MMF was administered from day 7. In the study group, the patients received additional CD25 monoclonal antibody for aGVHD prophylaxis. CD25 20 mg each by 30 min intravenous infusion on 2 hours before transplantation and day 4 after transplantation, was administered while no application of CD25 in the controls. The outcomes of transplantaton were compared between the study and control groups. The results showed that the median number of CD34 + cell in graft was 5.9×10 6/kg in the control group and 7.9×10 6/kg in the study group. The median number of CD3 + cell was 48×10 6/kg and 52×10 6/kg respectively (P>0.05). All patients showed 100% donor typed hematopoietic cells after transplantation by cytogenetic evidence. Five out of fifteen patients in the control group experienced Ⅱ-Ⅳ acute GVHD. While none of thirteen in the study group developed the Ⅱ-Ⅳ acute GVHD. However, none in both groups developed extensive cGVHD. The median follow up duration was 8 (3-15)months in the study group and 26 (15-36) months in control. In the study group, one patient died from transplant related mortality (CMV infection); no one relapsed; and 12/13 patients survived in disease free situation within the period of follow up. In the control group, six patients died from transplant related mortality (3 GVHD, 2 infection and 1 relapsed) and 9/15 patients survived in disease free situation. The one year probabilities of disease free survival (DFS) in two groups

关 键 词：CD25单克隆抗体 单倍体相合骨髓移植 G—csF预处理供者 异基因骨髓移植 白血病 

分 类 号：R733.7[医药卫生—肿瘤] R730.[医药卫生—临床医学]