非清髓性无关供者脐血移植与同胞供者骨髓移植治疗再生障碍性贫血的比较

目的 对非清髓性无关供者脐血移植与同胞供者骨髓移植治疗重型再生障碍性贫血(SAA)的临床效果进行评价和比较.方法 回顾性分析15例SAA患者进行非清髓性造血干细胞移植的临床资料,根据造血干细胞(HSC)来源的不同,将患者分为骨髓移植组(BMT组;6例)和脐血移植组(UCBT组;9例).对两组患者术后的外周血象、骨髓象、细胞嵌合体状态、移植物抗宿主病(GVHD)以及存活率等长期随访结果进行了统计学分析.结果 BMT组和UCBT组造血干细胞植入率分别为100%和66.7%,两组比较,差异有统计学意义(P＜0.05).UCBT组移植后大多数形成了供、受者型细胞混合嵌合体,BMT组大多数形成了供者型完全嵌合体.BMT组血象恢复正常的中位时间为25 d、UCBT组为120 d,BMT组骨髓象恢复正常的中位时间为25 d,UCBT组为150 d.BMT组慢性GVHD的表现以肝功能异常为主,而UCBT组则以皮疹为主.UCBT组术后早期感染率为33.3%,BMT组为16.7%.结论 非清髓性无关供者脐血移植和同胞供者骨髓移植均可成功治疗SAA;但与BMT比较,UCBT的造血功能恢复较慢、血型转变少而延迟、早期感染率较高、而慢性GVHD的程度却较轻.

Clinical comparision of non-myeloablative stem cell transplantation from related bone marrow vs unrelated umbilical cord blood for severe aplastic anemia

Objective To compare and evaluate the clinical effectiveness of non-myeloablative stem cell transplantation from related donor vs unrelated umbilical cord blood(UCB)for patients with severe aplastic anemia(SAA). Methods The clinical data of 15 patients with SAA were retrospectively analyzed. According to the sources of hematopoietic stem cells,patients were divided into bone marrow transplantation(BMT)group(n=6) and UCB transplantation(UCBT) group(n=9)and both of them subjected to nonmyeloablative stem cell transplantation. Long-term follow-up results including peripheral blood,bone marrow,chimerism status,graft-versus-host disease(GVHD),and survival rate were analyzed statistically. Results There was different engraftment rate between BMT group(100%)and UCBT group(66.7%)(P＜0.05). Most patients achieved mixed chimerism(MC)in UCBT group and full donor chimerism in BMT group. Patients achieved normal level of peripheral blood cell at median time of 120 days in UCBT group and 25 days in BMT group, and achieved normal haematopoietic level in bone marrow at median time of 40 days in BMT group and 150 days in UCBT group posttransplantation,respectively. Chronic GVHD mostly presented abnormal liver function and local skin rash in BMT and in UCBT groups respectively. There was different infectious incidence at early phase between UCBT group(33.3%) and BMT group(16.7%) (P＜0.05). Blood group in UCBT group had delayed and less change as compared with BMT group Conclusions Nonmyeloablative stem cell transplantation from related bone marrow and unrelated cord blood can achieved successful engraftment. In comparison to BMT group, patients in UCBT group were mostly characterized with slower hematopoietic recovery,less and delayed change of blood group,higher incidence of infection at early phase posttranplant,and milder chronic GVHD.