CAJ | 학술논문

目的观察造血干细胞移植(HSCT)治疗血液病的疗效,探讨移植相关并发症的预防及处理方法.方法回顾性分析采用HSCT治疗的110例血液病患者临床资料.61例患者采用自体外周血造血干细胞移植(auto-PBSCT)；49例患者采用异基因造血干细胞移植(allo-HSCT),其中,28例采用HLA全相合的同胞异基因外周血干细胞移植(allo-PBSCT),20例采用单倍体异基因骨髓+PBSCT,1例急性淋巴细胞白血病患儿采用脐带血HSCT.预处理方案:淋巴瘤患者采用BEAM方案(卡莫司汀+依托泊苷+阿糖胞苷+左旋苯丙氨酸氮芥),白血病患者采用改良的Bu/Cy方案(羟基脲+阿糖胞苷+白消安+环磷酰胺+司莫司汀),多发性骨髓瘤患者采用大剂量左旋苯丙氨酸氮芥方案,急性再生障碍性贫血患者采用FC(氟达拉滨+环磷酰胺)+兔抗人胸腺细胞球蛋白(ATG)方案.移植物抗宿主病(GVHD)的预防采用短程甲氨蝶呤+环孢素A+吗替麦考酚酯,单倍体移植患者加ATG.结果 109例(99.1％)患者成功获得造血重建,移植后中性粒细胞≥0.5×109/L、血小板≥20×109/L的平均天数在自体移植中分别为10d和12d,在异基因移植中分别为12d和15d；allo-HSCT中Ⅰ～Ⅲ度急性GVHD的发生率为28.6％(14/49),慢性GVHD的发生率为32.7％(16/49).中位随访36个月(1～60个月),84例(76.4％)患者无病生存,其中,auto-PBSCT组45例(73.8％),allo-HSCT组39例(79.6％)；26例(23.6％)死亡.auto-PBSCT组16例(26.2％)复发死亡,2例(3.3％)复发,无移植相关死亡；allo-HSCT组9例(18.4％)复发死亡,3例(6.1％)复发,1例(2.0％)发生移植相关死亡.结论 HSCT是治疗恶性血液病安全、有效的方法,也是治疗血液病的重要手段之一.
목적 관찰조혈간세포이식(HSCT)치료혈액병적료효,탐토이식상관병발증적예방급처리방법.방법 회고성분석채용HSCT치료적110례혈액병환자림상자료.61례환자채용자체외주혈조혈간세포이식(auto-PBSCT)；49례환자채용이기인조혈간세포이식(allo-HSCT),기중,28례채용HLA전상합적동포이기인외주혈간세포이식(allo-PBSCT),20례채용단배체이기인골수+PBSCT,1례급성림파세포백혈병환인채용제대혈HSCT.예처리방안:림파류환자채용BEAM방안(잡막사정+의탁박감+아당포감+좌선분병안산담개),백혈병환자채용개량적Bu/Cy방안(간기뇨+아당포감+백소안+배린선알+사막사정),다발성골수류환자채용대제량좌선분병안산담개방안,급성재생장애성빈혈환자채용FC(불체랍빈+배린선알)+토항인흉선세포구단백(ATG)방안.이식물항숙주병(GVHD)적예방채용단정갑안접령+배포소A+마체맥고분지,단배체이식환자가ATG.결과 109례(99.1％)환자성공획득조혈중건,이식후중성립세포≥0.5×109/L、혈소판≥20×109/L적평균천수재자체이식중분별위10d화12d,재이기인이식중분별위12d화15d；allo-HSCT중Ⅰ～Ⅲ도급성GVHD적발생솔위28.6％(14/49),만성GVHD적발생솔위32.7％(16/49).중위수방36개월(1～60개월),84례(76.4％)환자무병생존,기중,auto-PBSCT조45례(73.8％),allo-HSCT조39례(79.6％)；26례(23.6％)사망.auto-PBSCT조16례(26.2％)복발사망,2례(3.3％)복발,무이식상관사망；allo-HSCT조9례(18.4％)복발사망,3례(6.1％)복발,1례(2.0％)발생이식상관사망.결론 HSCT시치료악성혈액병안전、유효적방법,야시치료혈액병적중요수단지일.
Objective To observe the efficiency of hematopoietic stem cell transplantation to the treatment of hematological malignancies and explore prevention and treatment of the complications correlated with HSCT. Methods 110 patients with hematological malignancies which were treated by HSCT were recruited. 61 patients were treated with autologous peripheral blood hematopoietic stem cell transplantation (auto-PBSCT), 49 patients were treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT).Among them,there were 28 patients were used by all HLA-identical sibling allo-PBSCT,20 patients were used by haploid allogeneic bone marrow and peripheral blood stem cell transplantation, one case of acute lymphoblastic leukemia in children were treated with cord blood stem cell transplantation.Results 109(99.1％) patients acquired hemopoietic reconstruction. The median time of neutrophils≥0.5×109/L, and platelets≥20×109/L were 10 days and 12 days in auto-PBSCT,and were 12 days and 15 days in allo-PBSCT.The incidence of Ⅰ-Ⅲ degree of acute GVHD (aGVHD) in allogeneic transplantation was 28.6 ％(14/49),however,the incidence of chronic GVHD (cGVHD) was 32.6 ％(16/49).The median follow-up time was 36 (1～60) months.84 patients (76.4 ％) were disease-free.Among them,73.8 ％(45/61) were in auto-PBSCT group,(79.6 ％)39/49 were in allo-HSCT group.26 patients (23.6 ％) were died.There were 26.2 ％(16/61) who were in auto-PBSCT group died of disease relapse,3.3 ％(2/61) had disease relapse.There was no transplant-related deaths.18.4 ％(9/49) who were in allo-HSCT group died of disease relapse, 6.1％(3/49) had disease relapse, 2.0 ％(1/49) died of transplant-related deaths. Conclusion Hematopoietic stem cell transplantation is a safe and effective way for the treatment of malignant hematopathy patients,also an important mean for treatment of blood diseases.