异基因造血干细胞移植治疗难治性恶性淋巴瘤14例

异基因造血干细胞移植(allo-HSCT)是惟一有可能治愈恶性淋巴瘤的方法,尤其是发生骨髓侵犯或自体造血干细胞移植后复发的晚期难治性恶性淋巴瘤患者,有望再次长期缓解.     

亲缘异基因造血干细胞移植与自体造血干细胞移植治疗弥漫性大B细胞淋巴瘤大宗病例分析

选择自体造血干细胞移植还是异基凶造血干细胞移植治疗弥漫性大B细胞淋巴瘤（diffuse large B cell lymphoma,DLBCL）患者需权衡治疗相关死亡率（treatment—related mortality,TRM）差异、自体移植物被肿瘤污染的可能、干细胞动员失败和异基因移植物抗淋巴瘤效应等因素之间的利弊。     

异基因脐血造血干细胞移植

脐血是指胎儿娩出并断脐后保留在脐带和胎盘近胎儿一侧血管内的血液。脐血中富含造血干细胞，脐血造血干细胞则以其独特的生物学特性、资源优势以及临床适应证的广泛性等弥补了骨髓移植(BMT)和外周造血干细胞移植的不足。脐血造血干细胞移植(CBSCT)正日益受到人们的重视，已成为近几年来造血干细胞移植领域的重大进展之一。     

造血干细胞移植

20世纪50年代初期造血干细胞移植兴起,随着医学科技发展,大剂量化疗（预处理）＋造血干细胞移植为各种晚期肿瘤和癌症治疗提供了有力的支持,目前对造血干细胞的来源、种类、采集、活性测定,异基因造血干细胞的配型、动员剂的效果、骨髓中癌细胞污染的处理、移植后并发症的诊治、疾病观察指标、临床适应证和治疗效果的评估等等都逐渐规范化,且有很多治疗成功病例的报告。     

用于异基因移植的造血干细胞来源

造血干细胞移植(hcmatopoiedc stem cell transplantation，HSCT)的临床应用已有近50年的历史，目前已成为治疗多种良恶性血液病、实体肿瘤、遗传性疾病和重症自身免疫性疾病等的有效手段。本文试就异基因造血干细胞移植中应用的不同来源造血干细胞(hematopoietic stemcell，HSC)的特点及其对移植效果的影响作一评述。     

造血干细胞移植后并发带状疱疹临床分析

目的 探讨造血干细胞移植后带状疱疹发病情况、临床特点、治疗及转归.方法 回顾分析浙江省中医院血液科可评估的104例接受造血干细胞移植患者预处理方案、移植物抗宿主病预防方案及病毒感染的防治方案等临床资料.结果 104例接受造血干细胞移植患者中有24例(23.08% )并发带状疱疹,其中单倍体相合造血干细胞移植患者带状疱疹发生率为47.6%,非亲缘造血干细胞移植患者带状疱疹发生率为42.1%.应用抗病毒药物,适当减少免疫抑制剂用量及输注人免疫球蛋白,外用干扰素,同时中医中药辅助治疗,平均治疗(20.5±3.8)d后,患者疱疹全部消退,有4 例出现严重疱疹后神经痛,其中2例伴有局部肌肉萎缩.无泛发性疱疹及内脏受累病例,无疱疹相关死亡.结论 造血干细胞移植后发生的带状疱疹起病不典型,综合治疗能够有效地控制,但神经痛持续时间较长.     

造血干细胞移植的临床应用

造血干细胞移植(HSCT)是将造血干细胞植入患者体内予以重建造血和免疫系统的一种治疗方法。本文对HSCT在临床各个学科的应用作了较为全面的介绍，同时提出了HSCT面临的问题和挑战，     

造血干细胞移植治疗系统性红斑狼疮

本文综述了近10余年造血干细胞移植(haemopoieticstemcelltransplantation,HSCT)治疗系统性红斑狼疮(systemiclupuserythematosus,SLE)的相关进展。     

非亲缘脐血造血干细胞移植治疗儿童非霍奇金淋巴瘤1例报道

目的观察非亲缘异基因脐血造血干细胞移植治疗儿童非霍奇金淋巴瘤的临床效果。方法 1例5岁非霍奇金淋巴瘤（Ⅳ期）患儿接受了高剂量放化疗联合非亲缘异基因脐血造血干细胞移植的治疗。结果静脉输注脐血后无异常反应。白细胞植入时间为移植后17d,血小板植入时间为移植后25d。移植后出现Ⅰ度急性移植物抗宿主病（GVHD）,分别于24d、40d采集患者外周血,经短串联重复序列GeneScan方法分析判定供者造血干细胞在患者体内存活。患儿移植后43d出院,随访至2010年6月,已无病存活67个月,至今状况良好,无复发、无并发症、无慢性GVHD发生。结论大剂量化疗联合非亲缘异基因脐血造血干细胞移植治疗非霍奇金淋巴瘤儿童患者的移植效果较好,并发症较少。     

异基因造血干细胞移植研究进展

异基因造血干细胞移植已成为治愈血液系统恶性肿瘤、骨髓衰竭性疾病、某些先天性及代谢性疾病等的重要方法。本文就外周血干细胞移植（PBSCT）、脐血造血干细胞移植（CBSCT）、非清髓性干细胞移植（NST）、移植物抗宿主病（GVHD）与移植物抗白血病（GVL）效应以及间充质干细胞（MSC）在异基因造血干细胞移植中的应用等方面的新进展进行介绍。     

Lung transplantation after hematopoietic stem cell transplantation

Whitson BA, Shelstad RC, Hertz MI, Kelly RF, D’Cunha J, Shumway SJ. Lung transplantation after hematopoietic stem cell transplantation.
Clin Transplant 2011 DOI: 10.1111/j.1399‐0012.2011.01482.x.
© 2011 John Wiley & Sons A/S. Abstract: Introduction: Pulmonary insufficiency following bone marrow transplant (BMT) is common and has significant associated mortality. Lung transplantation (LTX) is the only viable treatment for patients with end‐stage pulmonary disease, but LTX after BMT is an uncommon event given the medical candidacy of the potential recipients. We sought to evaluate the short‐ and long‐term outcomes of LTX in BMT recipients. Methods: We performed a retrospective evaluation of our institution’s longitudinal LTX and BMT databases. Demographic and outcomes variables were collected. Results: We identified 639 LTX from January 1, 1988, through December 31, 2009, and 5525 BMT from program inception, March 21, 1974, through December 31, 2009. From the cross‐referenced cohort, we identified four patients who had BMT followed by LTX. Our series was composed of two men and two women, with a mean age of 32.3 yr (range, 20–59 yr). Single LTX were performed in two recipients (50%). All patients had significant and expected morbidities related to their transplant immunosuppression. Three patients (75%) required cardiopulmonary bypass at the time of LTX. The two recipients who underwent bilateral LTX required open chest management and subsequent tracheostomy. All patients are still alive at follow‐up (range, 19–119 months, median 39.5). Conclusion: Our study demonstrates that LTX in the setting of BMT is a high‐risk operation with the potential for a tumultuous perioperative course. Despite this, good outcomes and survival are obtainable in carefully selected patients. Selection factors include clinically stable patients without active sepsis and preoperative optimization of nutrition in anticipation of a prolonged recovery. An experienced multidisciplinary team approach and a protocol‐driven management plan are paramount for successful outcomes in this challenging population.     

造血干细胞移植后植入综合征研究进展

植入综合征是造血干细胞移植后中性粒细胞恢复初期发生的一种临床综合征,其临床上可以表现为发热、皮疹和毛细血管渗漏综合征,进而发展为肺实质浸润及体质量增加,甚至出现多器官功能衰竭。因其与急性移植物抗宿主病的表现接近,在其诊断及鉴别诊断方面有一定困难。本文就植入综合征发生情况、危险因素及其发病机制、诊断标准、治疗以及预后等方面进行综述。     

造血干细胞移植后病毒性肺炎(附视频)

造血干细胞移植(HSCT)后肺部并发症是影响HSCT受者预后的一个重要因素.近年来随着人们对肺部细菌、真菌及非感染性并发症等认识的深入,由病毒感染引起的肺部并发症再次成为人们关注的焦点.病毒性肺炎的病原体主要分为两大类:疱疹病毒和社区获得性呼吸道病毒.本文重点介绍HSCT后病毒性肺炎的流行病学、预防、诊断及治疗等方面的新进展.     

Costs of allogeneic hematopoietic stem cell transplantation

BACKGROUND: This study aims to determine the total costs after allogeneic hematopoietic stem cell transplantation (ASCT) and factors associated with increases or decreases in costs. METHODS: We collected all in- and outpatient costs during 5 years in 93 patients who had undergone ASCT in 1998 and 1999 at our unit. The inpatient costs included all those related to a patient from the first day of admission until discharge and then all costs of readmission in the Stockholm area. RESULTS: The total median cost of five posttransplant years was 139,414 (52,095-345,640) euros (euros) or 167,296 US dollars (the rate of 1 euro is approximately 1.2 US dollars). The costs were highest during the first year-median inpatient and outpatient costs 100,650 euros and 13,066 euros, respectively. The total costs during the first year were higher in patients with acute graft-versus-host disease grades III-IV (relative hazards [RH] 1.35, P = 0.003), bacteremia (RH 1.33, P = 0.005), veno-occlusive disease of the liver (RH 1.32, P = 0.005), prophylaxis with granulocyte colony-stimulating factor (G-CSF; RH 1.31, P = 0.01), acute leukemia (RH 1.32, P = 0.008), and treatment in hospital instead of at home (RH 1.20, P < 0.07). During the early transplant period, a second transplantation (RH 1.28, P = 0.014) and hemorrhagic cystitis (HC; RH 1.24, P = 0.03) were also associated with higher costs. The total 5-year cost declined with longer survival rates (r = 0.4028, P < 0.001) and reduced intensity conditioning (RH 0.79, P=0.024). CONCLUSION: Higher costs of ASCT were associated with retransplantation, acute leukemia, G-CSF prophylaxis, hospital care, myeloablative conditioning, and major transplant-related complications.     

Chronic kidney disease after hematopoietic stem cell transplantation

Acute and chronic kidney diseases occur after hematopoietic stem cell transplantation. These are caused by the transplant itself, and the complications of transplant. Recent estimates show that near 15% of subjects undergoing hematopoietic stem cell transplantation will develop chronic kidney disease, which is a complication rate that can affect outcome and reduce survival. Investigation of the causes of chronic kidney disease is needed, as are ways to prevent, mitigate, and treat it.     

Subsequent malignancies after allogeneic hematopoietic stem cell transplantation

We evaluated 979 patients for the development of post‐transplant lymphoproliferative disease (PTLD) and solid malignancies after allogeneic hematopoietic stem cell transplantations (allo‐HSCT) as a late complication. We found 15 (1.5%) subsequent malignancies; three of these malignancies were PTLD, and twelve were solid tumors. The median time from allo‐HSCT to the development of PTLD was 9 (3‐20) months and that from allo‐HSCT to the development of solid tumors was 93 (6‐316) months. The cumulative incidence of evolving subsequent malignancy in patients was 1.3% (±0.5 SE) at 5 years and 3.9% (±1.2 SE) at 10 years. The cumulative incidence of developing subsequent malignancy in patients with benign hematological diseases as the transplant indication was 7.4%±4.2 SE at 5 years. More subsequent malignancy developed in patients having ≥1 year chronic graft‐vs‐host disease (GVHD; 3.7% in ≥1 year chronic GVHD and 0.7% in <1 year chronic GVHD patient groups, P=.002). Subsequent epithelial tumor risk was higher in ≥1 year chronic GVHD patients than <1 year (3.7% vs 0.1%, P<.001). In multivariate analysis, benign hematological diseases as transplant indication (RR: 5.6, CI 95%: 1.4‐22.3, P=.015) and ≥1 year chronic GVHD (RR: 7.1, 95% CI: 2.3‐22.5, P=.001) were associated with the development of subsequent malignancy.     

造血干细胞移植的现状与展望

造血干细胞移植(Hematopoietic stem cell transplantation,HSCT)由美国Fred Hutchinson癌症研究中心的Thomas教授于20世纪50～70年代逐渐引入临床,Thomas教授也因此获得1990年诺贝尔医学奖.经过几十年的发展,HSCT已成为血液系统恶性疾病和部分非恶性疾病有效乃至惟一的根治手段.     

Membranoproliferative glomerulonephritis following allogeneic hematopoietic stem cell transplantation

Nephrotic syndrome after allogeneic hematopoietic stem cell transplantation has been increasingly described as a manifestation of chronic graft-versus-host disease (GVHD); however, GVHD-associated membranoproliferative glomerulonephritis is extremely rare. A 44-year-old man developed nephrotic syndrome 24 months after HSCT for acute lymphoblastic leukemia. The renal biopsy showed type I membranoproliferative glomerulonephritis. Salivary gland biopsy demonstrated mild lymphocytic infiltration, indicating chronic GVHD. Improvement of the proteinuria and recovery of renal function were achieved within 11 months of treatment with oral prednisolone and azathioprine.