异基因造血干细胞移植治疗恶性血液病的效果.doc

异基因造血干细胞移植治疗恶性血液病的效果
作者:袁成录李颖史春雷王玲

【关键词】造血干细胞移植;异基因;血液肿瘤;治疗结果
[摘要]目的探讨异基因造血干细胞移植(Allo-HSCT)治疗恶性血液病的效果。方法 10例恶性血液病病人进行Allo-HSCT治疗,供者中9例为HLA完全相合的同胞,1例为HLA半相合的同胞。预处理方案包括:马利兰-环磷酰胺、马法兰-足叶乙甙-阿糖胞苷-环磷酰胺、氟达拉滨-阿糖胞苷-马法兰-环磷酰胺、卡莫司汀-足叶乙甙-阿糖胞苷-环磷酰胺。结果全部病人均获得造血重建,中性粒细胞≥×109 /L、血小板>20×109 /、 d;5例发生急性移植物抗宿主病(GVHD),6例发生慢性GVHD,4例血型不合者均于移植后3个月内血型转为供者型。10例病人28 d时DNA图谱均转为供者型。随访4~23个月尚无复发及死亡病例。结论 Allo-HSCT虽然会发生GVHD等严重并发症,但仍然是治疗恶性血液病的最有效的方法。HLA半相合同胞Allo-HSCT的开展解决了供者来源少的难题。
[关键词] 造血干细胞移植;异基因;血液肿瘤;治疗结果
[ABSTRACT]ObjectiveTo study the efficacy of allogeneic hematopoietic stem cell transplantation (Allo-HSCT) for malig-nant hematopathy. MethodsTen patients with malignant hematopathy received Allo-HSCT. Nine donors were HLA-identical sibling, one was HLA-haploidentical sibling. The pretreatments included: Busulfan/Cyclophosphamide,Melphalan/Etoposide/Cytarabine/Cyclophosphamide,Fludarabine/Melphalan/Cytarabine/Cyclophosphame,BCNU/Etoposide/Cytarabine/Cyclophospha-mide. ResultsAll the patients engrafted gained hematopoietic reconstitution, absolute neutrophil count ≥×109 /L in days, platelet count >20×109 /L in days. Acute graft-versus-host disease (GVHD) was observed in five patients,and chronic GVHD in six. The blood type of four patients whose ABO blood type mismatched with the donors' were turned into donors' type in three months after HSCT. All patients of Allo-HSCT achieved full donor-type engraftment,proved by DNA order analysis in 28 days after Allo-HSCT. No relapse or death was found during four to 23 months' follow-up. ConclusionAllogeneic hematopoie- tic stem cell transplantation is the most effective method in the treatment of malignant hematopathy,although it causes the plication of graft-versus-host disease. HLA-haploidentical transplantation will solve the problem of donor-shortage.
[KEY WORDS]hematopoietic stem cell transplantation; allogeneic; hematological neoplasms; treatment e
近年来,随着血液学及相关领域基础和临床研究的不断进步,人们对造血干细胞移植的认识越来越深