减低预处理强度的异基因造血干细胞移植治疗恶性血液病疗效观察

本研究探讨减低预处理强度的异基因造血干细胞移植治疗恶性血液病的疗效和并发症。对10例血液系统恶性肿瘤患者进行减低预处理强度的亲缘异基因造血干细胞移植,其中6例CML患者,2例AML患者,1例ALL患者,1例淋巴瘤患者。供者皆为HLA全相合或部分相合同胞,预处理基本方案采用“FLU＋CY＋TBI”方案并结合患者实际病情适当加以改良,采用“CsA＋MMF”方案预防GVHD,移植术后通过骨髓细胞学、染色体、融合基因、ABO血型和STR—PCR方法等监测移植物植入情况以及移植效果,观察移植术后原发病复发、GVHD、移植并发症发生等情况,评估患者生活质量等,结果表明：10例患者全部移植成功,移植物顺利植入,原发病获得治愈。1例患者术后并发肺部严重感染,1例患者出现CMV血症,无其他明显并发症发生。10例患者中出现1例Ⅳ度aGVHD,2例Ⅰ度aGVHD,其余患者无明显GVHD发生。5例患者在移植术后不同时间点出现原发病复发,予以DLI或药物挽救治疗后重回CR状态。随访5月-35月余,10例患者中死亡2例,活存8例,总体生存率为80％,存活患者获得了高质量的生活。结论：减低预处理强度的造血干细胞移植对受者损伤小,移植效果可靠,术后GVHD、移植相关并发症少,患者术后生活质量高,移植后原发病复发患者仍可通过DLI以重新获得完全缓解。

Therapeutic Effect of Allogeneic Hematopoietic Stem Cell Transplantation with Reduced-intensity Conditioning Regimens on Hematological Malignancies

This study was aimed to investigate the therapeutic efficiency and complications after allo-hematopoietic stem cell transplantation (allo-HSCT) with reduced-intensity conditioning regimens in hematologic malignancies. 10 patients (6 CML patients, 2 AML patients, 1 ALL patient and 1 NHL patient) underwent related allogeneic hematopoietic stem cell transplantation with reduced-intensity conditioning regimens. The conditioning regimens consisted of "FLU + CY + TBI" basically and was appropriately improved in accordance with status of patients. Cyclosporin A (CsA) and mycophenolate mofetil (MMF) were used to prevent the graft-versus-host disease (GVHD). Detection of bone marrow cells, chromosomes, fused gene, ABO blood group and STR-PCR were used to observe engraftment, relapse, GVHD, transplantation- related complications (TRC) after transplantation and to evaluate patients quality of life. The results showed that the 10 patients successfully accepted the transplantation and their primary diseases were cured. In one patient, severe pulmonary infection happened, and in another one CMV infection occurred. Grade IV of acute GVHD occurred in one case and grade I of acute GVHD in 2 cases, the no chronic GVHD appeared. 5 patients relapsed after transplantation at various time points, the donor lymphocytes infusion (DLI) or drugs rescued these 5 patients. During median follow-up of 5 - 35 months, 2 out of which died, 8 survived, the overall survival rate was 80%, and the survivors live in a high-quality life. In conclusion, the hematopoietic stem cell transplantation with reduced intensity conditioning regimens was feasible with relatively low toxicity for recipients. GVHD and TRC were low, and life quality of patients after transplantation was high. DLI could cure the primary diseases even relapsed after transplantation.