造血干细胞移植治疗恶性血液病临床研究

 目的 探讨造血干细胞移植（HSCT）治疗恶性血液病的临床疗效及并发症的防治。方法51例急慢性白血病、恶性淋巴瘤、多发性骨髓瘤患者中，36例选择自体造血干细胞移植（auto-HSCT），15例接受异基因造血干细胞移植（allo-HSCT），包括HLA不全相合3例及非血缘关系移植4例，混合移植2例；预处理自体移植主要选用CBV，BEAC方案，异基因移植采用BU／CY2及改良的BU／CY方案；移植物抗宿主病（GVHD）的预防采用CsA+MTX或CsA+MTX＋MMF方案。结果 51例患者中49例获得造血重建，在auto-HSCT和allo-HSCT后WBC≥1.0×109／L的中位时间分别为13 d和17 d，血小板≥20×109／L的中位时间分别为21和25 d；40 ％出现aGVHD，26.7 ％出现cGVHD；3.9 %出现HVOD；出血性膀胱炎发生率5.9 ％；CMV感染发生率33.3 ％；62.7 ％出现黏膜炎；54.9 ％出现不同部位的感染；移植相关死亡率3.5 %，随访3～95个月，移植后复发11例，其中auto-HSCT 9例，allo-HSCT 2例。结论 HSCT是目前治疗恶性血液病的最佳方法，但移植期间需要进一步探索如何减少其相关并发症,以提高血液肿瘤的治愈率及延长患者的无病生存时间。

The clinical study of hematopoietic stem cell transplantation for hematological malignancies

Objective To investigate the clinical efficacy and complication of hematopoietic stem cell transplantation (HSCT) for hematological malignancies. Methods 51 patients with acute leukemia, chronic myeloid leukemia, malignant lymphoma and multiple myeloma, 36 patients were treated with auto-HSCT and 15 patients with allo-HSCT. 3 of 15 received HLA-mismatched allo-HSCT, 4 of 15 received unrelated donor bone marrow(URD-BMT), unrelated allo-PBSCT（URD-PBSCT） and umbilical cord blood transplantation(UCBT), mix-HSCT 2 cases; the conditioning regimens of auto-HSCT were BEAC / CBV, allo-HSCT were received BU/CY and modified BU/CY； mycophenolate mofetil(MMF)+CSA+MTX and CSA+MTX were giv－en to prevent acute graft－versus-host disease(aGVHD) for 15 patients. Results 49 of 51 patients reconstitut－ed hematopiesis.The median time for white blood cells ≥1.0×109/L were 13 days and 17 days, and platelets ≥20×109/L were 21 days and 25 days, in auto-HSCT and allo-HSCT after transplation respectively. The inci－dence of aGVHD was 40 % and of cGVHD was 26.7 %; the incidences of CMV, HC and HVOD were 33.3 %, 5.9 % and 3.9 %, respectively. Transplant-related mortality(TRM) was 3.5 %, 3 of 51 patients died of aGVHD and multiorgan failure. Conclusions HSCT is the best options as the treatment of patients with hematological malignancies. HSCT can increase CR rate and prolong the duration of disease-free survival (DFS) of patients with hematological malignanciy.