摘要
目的对66例血液病患者进行非血缘关系异基因造血干细胞移植(allo-HSCT),探索提高移植疗效的措施。方法慢性粒细胞白血病(CML)患者24例,急性白血病(AL)患者40例,其他血液病患者2例,经预处理治疗后,进行人类白细胞抗原(HLA)基本相合的非血缘关系骨髓移植(BMT)48例,外周血干细胞移植(PBSCT)18例。部分患者采用长程加强的移植物抗宿主病(GVHD)的预防方案(将环孢菌素A提前至预处理开始时使用,同时加用霉酚酸酯)。结果64例患者达到完全稳定的供者植入,WBC植活中位时间15d(BMT组16d;PBSCT组12d,P<0.01)。45例患者发生急性GVHD(aGVHD),累积发生率为71.16%,其中28例患者发生Ⅰ～Ⅱ度GVHD,累积发生率57.15%;17例患者发生Ⅲ～Ⅳ度GVHD,累积发生率32.25%;COX模型分析得出HLA配型及移植方式是影响aGVHD发生的因素,HLA配型相合、采用G-CSF动员的PBSCT可以降低aGVHD,尤其是重度GVHD的发生。可供分析的36例患者中有21例发生慢性GVHD。66例接受移植的患者中复发6例,死亡27例,5年的预期生存率为52.91%。用COX模型分析得出aGVHD以及aGVHD与GVHD的预防方案的交互因素是影响生存率的惟一因素,其相对危险度分别为1.517和1.255。结论提高非血缘关系allo-HSCT疗效的关键是控制aGVHD,而选择HLA配型相合的供者,加强移植早期的免疫抑制,可以减少aGVHD的发生。
Objective To improve the outcome of hematopoietic stem cell transplantation from unrelated donors. Methods Sixty-six patients with hematological diseases （40 cases of acute leukemia, 24 chronic myeloid leukemia, and one each severe aplastie anemia and β-thalassemia） rceived bone marrow （ BMT, n = 48） or peripheral blood stem cell transplantation （ PBSCT, n = 18 ） from HLA-compatible unrelated donors after BUCY or TBI conditioning. Forty patients received longer and intensive GVHD prophylaxis （ cyclos- porin A from day - 10 combined with mycophenolate mofetil）. Results Sixty-four patients achieved sustained donor engraftment. The median time of leukocyte engraftment was 15 days, being significantly earlier in PBSCT group compared with BMT group （ 12 vs 16 days, P = 0. 002）. The cumulative incidence rates of grades Ⅰ～Ⅱ and Ⅲ～Ⅳ acute GVHD at day 100 were 57. 15% and 32.25% , respectively. Chronic GVHD was seen in 21 of the 36 evaluable cases and ten of them were extensive type. Six patients relapsed and 27 dead, the overall survival at 5 years was 52.91%. The COX method analysis showed that HLA-compatible level and source of graft affected the incidence of aGVHD. The patients transplanted from HLAmatched donor with high resolution and PBSCT had the less probability for aGVHD. Patients without GVHD or with longer and intensive GVHD prophylaxis had significantly improved OS. Conclusion The key to improvement the outcome of HCT from unrelated donor is to reduce the incidence and severity of aGVHD by selecting the HLA-matched donor, intensifying the immunosuppression at the early stage of transplantation.
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2005年第11期656-660,共5页
Chinese Journal of Hematology
