CAJ | 학술논문

目的探讨异基因造血干细胞移植(allo-HSCT)治疗恶性血液病的疗效,观察造血重建、移植物抗宿主病(GVHD)发生、移植相关并发症及疾病的转归.方法回顾性分析allo-HSCT治疗恶性血液病患者20例,男15例,女5例,中位年龄39岁(8～59岁).供者于移植前3d采用重组人粒细胞集落刺激因子(rhG-CSF)行干细胞动员；预处理方案:人类白细胞抗原(HLA)亲缘全相合移植患者采用改良Bu/Cy方案；HLA亲缘不全相合者采用改良Bu/Cy+ATG方案；急性T淋巴细胞白血病(T-ALL)和多发性骨髓瘤(MM)患者采用Flu+Bu/Cy方案.GVHD预防方案:麦考酚酸酯+环孢素+短疗程甲氨蝶呤.结果 20例患者均成功获得造血重建,中性粒细胞计数＞0.5×109/L的中位时间为13d(12～17d),血小板＞20×109/L的中位时间为16d(12～23d),且供者CD34+细胞采集量＞2.5×106/kg(受者体质量)或单个核细胞采集量＞5.0×108/kg(受者体质量)所移植的患者造血重建较快.12例供受者血型不合,移植后未出现严重溶血反应；11例(55％)发生急性GVHD(aGVHD),包括Ⅰ度4例,Ⅱ度4例,Ⅲ度2例,Ⅳ度1例,均经治疗后好转.移植后所有患者均达到完全缓解(CR),中位随访6个月(2～14个月),1例白血病患者移植后5个月复发死亡,1例移植后4个月因自行停用环孢素发生自身免疫性溶血、慢性GVHD(cGVHD)、多器官衰竭死亡,其余患者仍处于CR状态.结论 allo-HSCT是治疗恶性血液病的有效方法.造血重建与采集物中造血干细胞的数量密切相关.ABO血型不合不是移植的障碍.复发、GVHD、感染是移植后死亡的重要原因.
목적 탐토이기인조혈간세포이식(allo-HSCT)치료악성혈액병적료효,관찰조혈중건、이식물항숙주병(GVHD)발생、이식상관병발증급질병적전귀.방법 회고성분석allo-HSCT치료악성혈액병환자20례,남15례,녀5례,중위년령39세(8～59세).공자우이식전3d채용중조인립세포집락자격인자(rhG-CSF)행간세포동원；예처리방안:인류백세포항원(HLA)친연전상합이식환자채용개량Bu/Cy방안；HLA친연불전상합자채용개량Bu/Cy+ATG방안；급성T림파세포백혈병(T-ALL)화다발성골수류(MM)환자채용Flu+Bu/Cy방안.GVHD예방방안:맥고분산지+배포소+단료정갑안접령.결과 20례환자균성공획득조혈중건,중성립세포계수＞0.5×109/L적중위시간위13d(12～17d),혈소판＞20×109/L적중위시간위16d(12～23d),차공자CD34+세포채집량＞2.5×106/kg(수자체질량)혹단개핵세포채집량＞5.0×108/kg(수자체질량)소이식적환자조혈중건교쾌.12례공수자혈형불합,이식후미출현엄중용혈반응；11례(55％)발생급성GVHD(aGVHD),포괄Ⅰ도4례,Ⅱ도4례,Ⅲ도2례,Ⅳ도1례,균경치료후호전.이식후소유환자균체도완전완해(CR),중위수방6개월(2～14개월),1례백혈병환자이식후5개월복발사망,1례이식후4개월인자행정용배포소발생자신면역성용혈、만성GVHD(cGVHD)、다기관쇠갈사망,기여환자잉처우CR상태.결론 allo-HSCT시치료악성혈액병적유효방법.조혈중건여채집물중조혈간세포적수량밀절상관.ABO혈형불합불시이식적장애.복발、GVHD、감염시이식후사망적중요원인.
Objective To evaluate the efficacy of allogeneic stem cell transplantation (allo-HSCT) in treatment of hematologic malignancies and observe hematopoietic reconstitution, graft versus host disease (GVHD) occurrence,transplant-related complications and the outcome of disease.Methods 20 patients with hematologic malignancies cured by allo-HSCT were analyzed retrospectively. 15 males and 5 females patients were enrolled, and the median age was 39 (8-59) years. Mobilization of donor’ s stem cells using rhG-CSF program 3 days before transplantation.Conditioning regimen:the patients with HLA-matched used modified Bu/Cy programs,the patients with HLA-mismatched (with 1 to 3 loci mismatched) used the modified Bu/Cy+ ATG program; the patient with T-ALL and the patient with MM used Flu+Bu/Cy program. GVHD prevention programs: mycophenolate mofetil + cyclosporine + short course methotrexate. Results 20 patients were successfully engrafted,the median time of absolute neutrophil count (ANC) ＞ 0.5×109/L was 13 (12-17) days,the median time of Plt ＞ 20×109/L was 16 (12-23) days, and the hematopoietic reconstitution was rapid in those patients who were transplanted by the donors with the collected amount of CDh cells ＞ 2.5× 106/kg (recipient body weigh) or the collected amount of mononuclear cell ＞ 5.0×10s/kg (recipient body weigh).No severe hemolytic reaction occurred in 11 cases of blood group incompatibility between donor and recipient after transplantation,11 cases (55 ％) developed acute GVHD (aGVHD):4 cases Ⅰ degree aGVHD,4 cases Ⅱ degree aGVHD,2 cases Ⅲ degree aGVHD,1 case Ⅳ degree aGVHD,all patients were improved after treatment.All patients attained complete remission (CR) after transplantation.Follow-up 6 (2-14) months,1 patient died in 5 months after transplantation because of leukemia relapse, 1 case died in 4 months after transplantation because of self-disabling autoimmune hemolytic cyclosporine, chronic GVHD (cGVHD) and multiple organ failure,the remaining patients still were in CR state.Conclusion Allo-HSCT is the effective way to treat hematologic malignancies. Engraftment is closely related with the quantity of hematopoietic stem cells from donor.Blood group incompatibility was not an obstacle for transplantion.Relapse,GVHD,infection are the major cause of death after transplantation.