非血缘供者异基因外周血造血干细胞联合脐带间充质干细胞移植治疗恶性血液病临床研究  

Unrelated Donor Peripheral Blood Stem Cell Transplantation Combined with Umbilical Cord Mesenchymal Stem Cells in Patients with Hematologic Malignancies

作　　者：张晓婷[1] 段连宁[1] 丁丽[2] 朱玲[2] 闫洪敏[2] 王志东[2] 汪生[2] 郑晓丽[2] 董磊[2] 薛梅[2] 刘静[2] 王恒湘[2] 

机构地区：[1]大连医科大学临床医学系,辽宁大连116044 [2]空军总医院血液科,北京100142

出　　处：《中国实验血液学杂志》2015年第5期1445-1450,共6页Journal of Experimental Hematology

摘　　要：目的:探讨非血缘供者异基因外周血造血干细胞(URD-PBSC)和脐带间充质干细胞(UC-MSC)联合移植治疗恶性血液病的疗效及安全性。方法:回顾分析我院49例接受非血缘供者异基因外周血造血干细胞移植(URD-PBSCT)治疗恶性血液病患者的临床资料,其中包括急性非淋巴细胞白血病(ANLL)12例,急性淋巴细胞白血病(ALL)17例,慢性粒细胞白血病(CML)18例,骨髓增生异常综合征(MDS)2例。UC-MSC+URD-PBSCT组22例,URD-PBSCT组27例,UC-MSC+URD-PBSCT组平均回输UC-MSC数为1.0×106/kg。结果:与URD-PBSCT组相比,UC-MSC+URD-PBSCT组粒细胞植入中位时间短(12 d vs 15 d)(P=0.041);慢性移植物抗宿主病(cGVHD)发生率及严重程度低(20.0%vs 51.9%)(P=0.026);(5.0%vs 33.3%)(P=0.040);移植后巨细胞病毒(CMV)感染率高(81.8%vs 51.9%)(P=0.028)。两组之间移植后造血干细胞植入率,血小板重建,急性移植物抗宿主病(aGVHD)的发生率及严重程度,肺部感染,出血性膀胱炎,1年复发率及1年生存率无明显差异(P>0.05)。结论:联合UC-MSC的异基因造血干细胞移植安全、有效,粒细胞重建快,cGVHD发生率及严重程度低,但应注意防治CMV感染的发生。Objective: To explore the safety and efficiency of unrelated donor peripheral blood stem cells( URDPBSC)transplantation combined with umbilical cord mesenchymal stem cells( UC-MSC). Methods: The clinical data of 49 patients received unrelated donor peripheral blood stem cells transplantation( URD-PBSCT) for treating hematologic malignancies were retrospectively evaluated,including 12 ANLL,17 ALL,18 CML and 2 MDS. Out of them,22 patients received the URD-PBSCT combined with UC-MSC and 27 patients received only URD-PBSCT. The average number of infusing UC-MSC was 1. 0 × 106 /kg in the UC-MSC + URD-PBSCT group. Results: As compared with URD-PBSCT group,in UC-MSC + URD-PBSCT group the median recovery time of neutrophilc granulocytes was shorter( 12 d vs 15 d)( P = 0. 041),the incidence and severity of chronic graft versus host disease( cGVHD) were lower( 20. 0% vs 51. 9%)( P = 0. 026)( 5. 0% vs 33. 3%)( P = 0. 040),the incidence of CMV infection after transplatation was higher( 81. 8% vs 51. 9%)( P = 0. 028). In addition to these,the differences were not statistically significant in term of implantation level,PLT reconstitution,aGVHD,lung infection,hemorrhagic cystitis,1-year relapse and survival between the 2 groups( P > 0. 05). Conclusion: The transplantation of URD-PBSC combined with UC-MSC is effective and safe. The speed of neutrophils reconstitution is faster. The incidence and severity of cGVHD are lower,but the attention should be paid to prevent the CMV infection.

关 键 词：间充质干细胞移植 外周血干细胞移植 血液肿瘤 非血缘供者 

分 类 号：R457.7[医药卫生—治疗学] R733.7[医药卫生—临床医学]