非清髓异基因造血干细胞移植治疗恶性血液病临床分析

#临床研究#非清髓异基因造血干细胞移植

治疗恶性血液病临床分析*

赵刚1陈宝安1丁家华1董伟民1邓晓静1

[摘要]目的:观察非清髓异基因造血干细胞移植(NST)治疗恶性血液病的疗效及并发症的处理。方法:对

33例恶性血液病患者施行NST并随访观察。预处理方案应用氟达拉滨30mg#m-2#d-1(-7~-2d),马利兰

4mg#kg-1#d-1(-6~-5d),环磷酰胺350mg#m-2#d-1(-3~-2d),H L A不全相合者加用抗淋巴细胞

球蛋白(A LG)750mg/d(-2~-1d)。移植物抗宿主病(G VH D)预防应用环孢素A(CsA)和骁悉(M M F)。应用

美司那、大量水化、碱化尿液预防出血性膀胱炎。应用凯时(前列腺素E1)预防肝静脉闭塞病(VO D)。结果:全部

患者均成功植入,造血重建速度快。中性粒细胞>0.5@109/L的中位时间是+13(+10~+16)d,血小板>20@ 109/L的中位时间是+12(+9~+25)d。3例患者在+100d左右出现间质性肺炎,血CM V-DN A阳性,应用更

昔洛维抗病毒等治疗后均痊愈。17例患者发生急性移植物抗宿主病(aG VH D)(5115%),Ñ度患者10例(3013%),Ò度患者5例(15.2%),Ó度患者2例(6.06%)。有20例患者出现慢性移植物抗宿主病(cGV HD) (6415%),其中局限型15例(48.4%),广泛型5例(16.1%)。有3例患者出现V OD(9.1%),5例患者出现出血

性膀胱炎(15.2%),经积极治疗均有效控制。中位随访37(2.5~58.0)个月,现存活24例(72.7%),9例死亡(27.3%),5例疾病复发(15.2%)。9例死亡患者中7例死于GV H D,2例死于疾病复发。结论:NST植入可靠,

造血重建快,复发率低,移植相关并发症感染、出血性膀胱炎、VO D发生率低,治疗安全、有效。但GV HD发生率

较高,是导致死亡的主要原因。

[关键词]非清髓,异基因造血干细胞移植;移植物抗宿主病;肝静脉闭塞病;出血性膀胱炎

[中图分类号]R617[文献标志码]A[文章编号]1004-2806(2010)01-0005-04

Nonmyeloablative allogeneic peripheral blood hematopoietic stem cells transplantation for hematological malignancies:an elemental

clinical outcome analysis

ZH A O Gang CH EN B aoan DI N G J iahua DON G Weimin DEN G X iaoj ing (Depar tm ent of H emato logy,Zhongda H ospital o f So utheast U niv ersity,Nanjing,210009, China)

Abstract Objective:T o ex plor e t he sig nificance of nonmyeloablative allog eneic peripheral blood hemat opoietic stem cell tr ansplantation in the treatment of the hemato log ical ma lig nancies.Method:T hirt y-three patient s r eceived nonmyeloablative allog eneic stem cell tr ansplantation(NST).T he nonmyelo ablativ e conditioning reg imen consis-

ted o f fludar abine,busulfan,cy clophosphamide and cytar abine w as used for so me patients,A LG was used f or those w ho wer e HL A-mismatched donors.T he gr aft v ersus host disease(GV HD)prophylaxis included cyclospo-rine A(CsA)and mycopheno late mofetil(M M F).w e used mesna for the pro phy lax is of hemor rhag ic cystitis (HC)and pro staglandin E1for hepatic veno-occlusiv e disease(V OD).Result:A ll patients show ed a rapid hemato-

po ietic r econst itution.T he median time for neutro pils co unt to r each0.5@109/L w as13days,and that for plate-

lets count to r each t o20@109/L w as12day s respect ively.In this series,acute G V HD occurred in17patient s (51.5%),and chro nic G VH D dev eloped in20o f31pat ients sur viving beyond100days.A fter a median follow-up

of37mo nt hs,24patients are still aliv e(72.7%).T hree patients occurr ed V O D and five patients o ccurr ed HC. Conclusion:T his clinical analysis sug gests that N ST perfo rmed in hemato lo gic malignancies is pr act ital and accepta-ble,and may be associated with a rapid hemato po ietic reconst itution,a lo wer t ransplant-r elated mo rtality and a h-i gner risk of G VH D.

Key w ords no nm yelo ablativ e allo geneic stem cell tr ansplantatio n;g raft v ersus host desease;hepatic v eno-oc-clusive disease;hemo rr hagic cystitis

*基金项目:江苏省重点学科开放课题(N o:k0613) 1东南大学附属中大医院血液科(南京,210009)

通信作者:陈宝安,E-mail:cha8888@hotmail.co m

非清髓性造血干细胞移植(nonmyeloablative stem cell tr ansplantation,NST)近年来逐渐开展并被证实有效,它应用剂量相对较低的非清除性预处