HLA不全相合造血干细胞联合脐血移植治疗急性白血病的临床观察

目的观察HLA不全相合造血干细胞联合脐血移植治疗急性白血病的有效性及安全性。方法 2008年6月～2010年12月本科20名急性白血病患者接受HLA不全相合造血干细胞联合脐血移植,和同期进行的HLA不全相合造血干细胞移植的51名急性白血病患者,进行造血重建、植入,移植相关并发症和疗效方面的比较。结果联合移植组平均输入脐血有核细胞数2.96×107/kg,CD34+细胞2.99×105/kg;1名患者未植入,ANC≥0.5×109/L的平均时间为12.6±2.50 d,Plt≥20×109/L的平均时间为17.2±3.70 d和对照组均无显著差异(P0.05);植入检查均为完全供者型;联合移植组Ⅲ～Ⅳ度的严重aGVHD的发生率为5.0%显著低于对照组的11.7%(P0.05);1年OS联合移植组为80%优于对照组的72.5%(P0.05);两组间cGVHD发生率、复发率和感染并发症的比较无统计学意义(P0.05)。结论 HLA不全相合造血干细胞联合脐血移植降低严重aGVHD的发生率,提高长期生存率,是对HLA不全相合造血干细胞移植方法的改良,临床应用安全有效。

Clinical study of the HLA-mismatched hematopoietic stem cell transplantation combined with Umbilical Cord Blood for the treatment of acute leukemia

Objective To explore the effectiveness of HLA-mismatched hematopoietic stem cell transplantation combined with Umbilical Cord Blood transplantation in treatment of acute leukemia.Methods From June 2008 to December 2009,twenty patients with acute leukemia in our hospital received HLA-mismatched hematopoietic stem cell transplantation combined with Umbilical Cord Blood and fifty one patients received HLA-mismatched hematopoietic stem cell transplantation.Implantation level and recovery of bone marrow,transplantation-related complications and therapeutic effect were compared between the two groups.Results The average counts of nucleated cells in cord blood were 2.96×107/kg and CD34+ cells were 2.99×105/ kg.One patients did not achieve engraftment in combined transplantation group.The mean time for absolute neutrophil count to be over 0.5×109/L was(12.6±2.50) d,and that of platelet count over 20×109/L was(17.2±3.70) d,respectively in the combination transplantation group,not significant different from those in the control group(P>0.05).The incidence of grade Ⅲ~Ⅳ severe acute graft versus host disease(GVHD) was 5.0% in combined transplantation group,lower than in control group(P<0.05).One year OS in combined transplantation group was 80% better than the 72.5% in the control group(P<0.05).However,no statistical differences were observed in chronic GVHD,infection and 1-year relapse between the two groups(P>0.05).Conclusion HLA-mismatched hematopoietic stem cell transplantation combined with Umbilical Cord Blood transplantation can decrease the incidence of the severe aGVHD and improve long term survival.It is a safe and effective method of HLA-mismatched hematopoietic stem cell transplantation.