增加强度预处理单倍体造血干细胞移植治疗10例HLA供者特异性抗体(DSA)强阳性血液病患者临床观察  

Impact of immunosuppression intensified conditioning regimen for patients with strong positive pre-transplantation donor-specific anti-HLA antibodies(DSAs)undergoing haploidentical hematopoietic stem cell transplantation

作　　者：刘慧霞 魏道林 邵珊 蒋瑛 李肃 朱骏 王椿 赵初娴 Liu Huixia;Wei Daolin;Shao Shan;Jiang Ying;Li Su;Zhu Jun;Wang Chun;Zhao Chuxian(Department of Hematology,Shanghai Zhaxin Traditional Chinese&Western Medicine Hospital,Shanghai 200435,China)

机构地区：[1]上海闸新中西医结合医院血液科,上海200435

出　　处：《中华血液学杂志》2023年第8期654-659,共6页Chinese Journal of Hematology

摘　　要：目的探讨增加强度预处理单倍体造血干细胞移植(haplo-HSCT)对于HLA供者特异性抗体(DSA)强阳性血液病患者的疗效。方法纳入2019年5月1日至2022年9月1日在上海闸新中西医结合医院血液科接受增加强度预处理haplo-HSCT的DSA平均荧光强度(MFI值)≥10 000的10例血液病患者,对其临床资料进行回顾性分析。结果①10例患者中男3例、女7例,中位年龄为53.5(36~64)岁;急性髓系白血病(AML) 3例,骨髓增生异常综合征(MDS)2例,慢性粒-单核细胞白血病(CMML)2例,慢性髓性白血病加速期(CML-AP)2例,原发性骨髓纤维化(PMF)1例。②接受氟达拉滨(Flu)/白消安(Bu)为主联合全身放射治疗(TBI)/环磷酰胺(CTX)预处理方案。③移植前DSA中位MFI值为15 999(10 210~23 417),移植后第7天DSA中位MFI值为10 787(0~22 720)。④8例患者获得粒细胞和血小板植入,中位粒细胞植入时间为14(10~16)d,中位血小板植入时间为18(14~20)d。中位随访12.5(1.5~27)个月,原发植入失败、移植物植入功能不良患者各1例,7例患者DSA转为阴性且处于无进展生存状态。结论增加强度预处理haplo-HSCT能够有效降低DSA强阳性血液病患者DSA强度,获得较好的近期疗效。Objective To explore the efficacy of immunosuppression intensified conditioning regimen in patients who have strongly positive donor-specific Anti-HLA antibodies(DSAs)and received a haploidentical hematopoietic stem cell transplantation(haplo-HSCT).Methods Clinical data of 10 patients with strongly positive pretransplant DSAs(defined as MFI≥10000)were retrospectively analyzed in this study.All of them received a haplo-HSCT in the Hematology Department of Shanghai Zhaxin Traditional Chinese&Western Medicine Hospital.Results①Of all ten patients,three were males,and seven were females,with a median age of 53.5(36-64)years.Of the 10 patients,three were diagnosed with acute myeloid leukemia,two were myelodysplastic syndromes(MDS),two were chronic myelomonocytic leukemia(CMML),two were in an accelerated phase of chronic myeloid leukemia(CML-AP),and one was primary myelofibrosis(PMF).②Conditioning regimen consisted of fludarabine(Flu)/busulfan(Bu)combined with whole-body irradiation(TBI)/cyclophosphamide(Cy).③On the seventh day after transplantation,the median pretransplant DSA level was MFI 15999(10210-23417)and 10787(0-22720).④Eight patients acquired hematopoietic reconstitution;the median time of neutrophil engraftment was 14(10-16)days;and 18(14-20)days for platelet engraftment.After a median follow-up of 12.5(1.5-27)months,primary graft failure was found in one patient and another with poor graft function.Seven patients remained in a disease remission state,and all were DSA-negative.Conclusions An intensified immunosuppression conditioning regimen can efficiently decrease the level of donor-specific anti-HLA antibodies(DSAs),leading to good short-term efficacy.

关 键 词：单倍体造血干细胞移植 预处理 供者特异性抗体 

分 类 号：R457.7[医药卫生—治疗学] R55[医药卫生—临床医学]