HLA单倍体与全相合异基因造血干细胞移植治疗恶性血液病

背景:异基因造血干细胞移植是治疗恶性血液病的一种非常有效的方法。单倍体相合的造血干细胞移植扩大了移植的应用范围,是无HLA相合供者患者的一种重要选择。目的:比较HLA单倍体相合与全相合异基因造血干细胞移植治疗恶性血液病的临床疗效。方法:回顾性分析接受异基因造血干细胞移植79例恶性血液病患者的临床资料,其中HLA单倍体相合组26例、全相合组53例,对比两组受者移植物抗宿主病的发生率、复发率、2年生存率等。结果与结论:78例受者获得完全、持久供者干细胞植入;1例受者在移植后28 d尚未植入,后因感染死亡。两组慢性移植物抗宿主病发生率、复发率和2年无病生存率差异无显著性意义(P>0.05)。单倍体相合组急性移植物抗宿主病发生率高于全相合组(P<0.05);2年总生存率低于全相合组(P<0.05)。提示血缘HLA单倍体相合移植治疗恶性血液病的安全性及疗效接近于全相合移植,在缺乏HLA相合供者的情况下,行HLA单倍体相合造血干细胞移植治疗恶性血液病是切实可行的选择。

HLA haploidentical and matched allogeneic hematopoietic stem cell transplantation in treatment of hematological malignancies

BACKGROUND：Allogeneic hematopoietic stem cell transplantation （HSCT） is a very effective method in the treatment of hematologic malignancies. The haploidentical HSCT can expand the application of transplantation, and is also an important option for the patients who need a salvage transplantation without a HLA-matched donor. OBJECTIVE：To compare the therapeutic effects of HLA haploidentical and sibling HLA-matched allogeneic HSCT in the treatment of hematologic malignancies.METHODS：The clinical outcomes of 79 patients with hematologic malignancies who received allogeneic HSCT, including 26 patients with related HLA-mismatched donors and 53 patients with HLA-matched sibling were retrospectively analyzed.The incidence of graft versus host disease （GVHD）, recurrence rate, and 2-year survival rate were compared between HLA-haploidentical and HLA-matched cohorts.RESULTS AND CONCLUSION：78 patients achieved full engraftment, but a patient died of severe infection without engraftment at 28 days after transplantation. There was no significant difference in incidence of GVHD, incidence of relapse and 2-year disease-free survival （DFS） between HLA-haploidentical and HLA-matched cohorts （P 0.05）. The incidence of GVHD in HLA-haploidentical cohorts was significantly higher than in HLA-matched cohorts （P 0.05）, and 2-year overall survival was lower （P 0.05） than the latter. The results suggested that the safety and effect of haploidentical HSCT with modified conditioning regimen were similar to HLA-matched HSCT for hematologic malignancies. Haploidentical HSCT is a safe and feasible approach in the treatment of hematologic malignancies without a HLA-matched related or unrelated donor.