不同类型异基因造血干细胞移植后的急性白血病患者骨髓形态学比较

目的观察单体型相合造血干细胞移植及全相合异基因造血干细胞移植后骨髓形态学差异及造血重建情况。方法在235名实施异基因造血干细胞移植患者中,单体型相合120名,采用外周血造血干细胞联合骨髓移植;115名全相合的患者,采用单纯的外周血造血干细胞移植。在造血干细胞移植成功出层流室+30 d行骨髓穿刺抽吸涂片观察骨髓形态学差异,并观察造血重建情况。结果 235名患者均成功重建造血。全相合患者白细胞及血小板重建的时间分别14.7 d(12～26 d)及20.6 d(13～32 d);单体型相合造血干细胞移植患者白细胞及血小板重建的时间分别12 d(10～21 d)及18 d(15～30 d);2者之间的差异具有统计学意义(P0.05)。2组患者造血干细胞移植后骨髓全部完全缓解。在骨髓增生程度、粒红比例和细胞形态等方面有差异,但差异无统计学意义(P0.05)。结论单体型相合造血干细胞移植较全相合移植造血重建早,移植后骨髓形态学有差异,但差异无统计学意义。

Difference in bone marrow morphology among different allogeneic transplantations in patients with acute leukemia

Objective To observe the difference in bone marrow morphology after haploidentical hematopoietic stem cell transplantation(HSCT) and matched HSCT and the hematopoietic reconstitution.Methods 235 patients underwent HSCT,among which 120 patients underwent haploidentical HSCT using both peripheral blood stem cells and bone marrow,and 115 patients underwent matched allogeneic HSCT using only peripheral blood stem cells.Two or more smears were made for the examination of peripheral blood and bone marrow cellular morphology after hematopoietic reconstitution for +30 days.Results All patients achieved successful engraftment.The time of hematopoietic reconstitution for WBC(ANC>0.5×109/L) and PLT(>20×109/L) was 14.7 d(12 d～26 d),and 20.6 d(13 d～32 d),respectively,for matched allogeneic HSCT;and 12 d(10 d～21 d),and 18 d(15 d～30 d),respectively,for haploidentical HSCT,with statistically significant difference between matched allogeneic HSCT and haploidentical HSCT.The bone marrow showed complete remission for all patients.There was no statistically significant difference between the two types of transplantation,athough there was difference in the degree of hyperplasia,the ratio of granulocyte to erythrocytes and the cell morphology.Conclusion Hematopoietic reconstituttion is earlier in haploidentical HSCT than matched allogeneic HSCT.There is no statistically significant difference in the morphology of bone marrow.