亲代间单倍体相合造血干细胞移植治疗血液病45例临床分析

目的观察亲代间单倍体相合造血干细胞移植治疗血液病的临床疗效。方法第三军医大学新桥医院血液科自2007年7月-2011年1月,对45例患者实施父母供子女的亲代间单倍体相合造血干细胞移植,观察其临床疗效及并发症。结果 43例患者造血重建成功,2例患者植入失败。移植物抗宿主病(GVHD)发生率为62.2%,其中急性GVHD发生率为40.0%,慢性GVHD发生率为22.2%。与母亲作为供者相比,父亲作为供者时患者GVHD的发生率较低。GVHD的发生率与供者年龄、HLA配型相合位点数目有关。移植后并发的感染中以血源性巨细胞病毒感染和肺部感染为多。随访6个月~4年,移植成功的43例患者中共死亡6例,主要死因为感染和原始疾病复发,患者存活率86.7%。7例患者采用联合脐血移植,与单纯采用亲代间单倍体造血干细胞移植者相比,其造血重建时间提前,GVHD发生率占总发生率的7.14%。结论亲代间单倍体造血干细胞移植对治疗血液病有效,应选择HLA配型相合位点数目较多、男性、年轻供者。亲代间单倍体相合造血干细胞移植联合脐血移植,造血重建较快、GVHD发生率较低。

Parental haploidentical hematopoietic stem cell transplantation for hematologic diseases:a report of 45 cases

Objective The present report describes the clinical effects of parental haploidentical hematopoietic stem cell transplantation in the treatment of hematologic diseases.Methods A total of 45 patients received parental haploidentical hematopoietic stem cell transplantation from July 2007 to January 2011.The therapeutic effects and complications were observed.Results Engraftment was successful in a total of 43 patients.Implantation failed in two patients.The incidence of the graft versus host disease(GVHD) was 62.2%.The incidence of acute GVHD was 40.0%,and chronic GVHD occurred in 22.2% of the patients.The incidence of GVHD was lower when the father was the donor,as compared with the mother as the donor.The incidence of GVHD was related to the age of the donor and the number HLA matching sites.In addition,infections observed in the in the present study were mainly blood-borne with cytomegalovirus as the invader and lung infections.During the follow-up period of 6 months to 4 years,six patients died among 43 patients with successful implantation.The major cause of death was infection and a relapse of the original disease.The disease free survival(DFS) rate was 86.7%.Among,seven patients who also received umbilical cord blood,the effect of the transplantation seemed better than those who received parental stem cells only,as hematopoietic reconstruction was faster and the incidence of GVHD only accounted for 7.14% of the total incidence rate.Conclusions Parental hi-allo-HSCT is an effective treatment of hematologic diseases.A young male donor with more HLA matching sites is recommended to prevent GVHD and infection.The combination of parental hi-allo-HSCT and umbilical cord blood transplantation resulted in positive effects with faster hematopoietic reconstruction and a lower incidence of GVHD.