外周造血干细胞移植病人的心理干预

目的 探讨造血干细胞移植病人心理状态,以便有针对性地进行心理干预.方法 通过护理人员细心周全观察,分析患者的心理特征,在临床工作中对患者进行针对性的心理护理.结果 进入层流病房实施造血干细胞移植病人主要表现为对环境陌生的孤独、焦虑、紧张、恐惧、兴奋、担忧.结论 观察患者的心理特征,并给予相应的心理护理,减轻患者的不良心理,使患者身心早日康复.     

造血干细胞移植患者相关心理社会因素的研究现状

近二十年来造血干细胞移植(ＨｅｍａｔｏｐｏｉｅｔｉｃＳｔｅｍＣｅｌｌＴｒａｎｓｐｌａｎｔａｔｉｏｎ ,ＨＳＣＴ)已广泛地应用于治疗恶性血液病 ,恶性实体瘤及某些先天性及后天性疾患 ,使得ＨＳＣＴ相关的生物医学方面的研究取得长足的进步。随着传统生物医学模式逐渐向生物 -心理 -社会医学模式转化 ,对移植治疗相关的心理社会因素的研究也日益增多[1] 。但国内这方面的研究尚不多 ,本文就ＨＳＣＴ相关的心理社会因素问题综述如下。一、概述ＨＳＣＴ是目前治疗恶性肿瘤的有效手段之一 ,其最常见的适应症是何杰金病、非何杰金淋巴瘤、白…     

造血干细胞移植与自身免疫病

自身免疫与免疫耐受是当今免疫学研究的中心课题。随着免疫应答,免疫耐受机理被逐步揭示,自身免疫病的治疗越来越受到研究者及临床医生的关注。近年的研究表明造血干细胞的异常是导致自身免疫疾病的发生的根本原因,其中很多自身免疫病已在基因水平找到了相应的缺陷。本文拟从动物实验及临床治疗两方面对用造血干细胞移植治疗自身免疫病的研究与应用作一综述。     

造血干细胞移植的免疫问题

造血干细胞移植作为血液恶性疾病的治疗手段已越来越获公认,其重要原因之一就是造血干细胞移植融化疗与免疫治疗于一体。造血干细胞移植的临床快速发展,丰富了移植免疫理论,移植免疫的进展促进了造血干细胞移植的临床实践。造血干细胞移植的诸多问题,如GVHD、GVL、免疫耐受等均有其免疫的机制。为更好地理解、认识这些问题,本文将从免疫学的角度对这些现象作一分析。1 T细胞抗原识别和激活的分子基础在造血干细胞移植,由于受者在移植前接受了预处理的超大剂量放/化疗,受者免疫功能受到抑制,因此,更多的情况是发生供者对受者的…     

造血干细胞移植与自身免疫病

自身免疫与免疫耐受是当今免疫学研究的中心课题。随着免疫应答、免疫耐受机理被逐步揭示,自身免疫病的治疗越来越受到研究者及临床医生的关注。近年的研究表明造血干细胞的异常是导致自身免疫病的发生的根本原因,其中很多自身免疫病已在基因水平找到了相应的缺陷。本文拟从动物实验及临床治疗两方面对用造血干细胞移植治疗自身免疫病的研究与应用作一综述     

供受者感染乙肝病毒对造血干细胞移植后肝炎复发及愈后的影响

目的分析移植前供、受者感染乙肝病毒对造血干细胞移植后肝炎复发及愈后的影响。方法对上海第一人民医院2006年1～11月移植前供、受者感染乙肝病毒的23例恶性血液病患者,进行移植前后肝功能、乙肝免疫标记物、HBVDNA等检测,并结合临床综合分析。血清丙氨酸氨基转移酶（ALT）、γ谷氨酰转肽酶（GGT）采用速率法,血清总胆红素（TBIL）采用终点比色法检测;乙肝病毒血清标志物采用酶免疫测定（EIA）;HBVDNA测定采用聚合酶链反应（PCR）试剂盒。结果①9例HBV感染的自体移植患者移植后3例发生乙型肝炎,其中2例为移植前HBsAg阳性,乙肝发作时3例HBVDNA及肝功能指标均明显增高;②14例HBV感染的供、受者移植后5例患者发生乙型肝炎,HBVDNA及肝功能指标均明显增高;③移植前HBsAg或HBVDNA阳性移植后发生乙肝相关性肝损的几率显著高于阴性组（X^2分别为8.44、9.07,均大于X0.005^2,P〈0.005）;④移植前HBsAg或HBVDNA阳性对移植预后均无影响（X^2分别为2.58、0.24,均小于X0.05^2,P〉0.05）;⑤1例患者异体移植后41d,乙肝合并戊肝,发生急性黄疸性肝炎,第46天重症GVHD死亡。结论移植前HBsAg和HBVDNA阳性均是HBV感染和再激活的高危因素,移植要密切监测免疫标志物和HBVDNA。移植前HBsAg和HBVDNA阳性不影响患者的生存,要注意非常见肝炎的多重感染。     

造血干细胞移植患者早期发生呼吸道感染的危险因素分析

目的:研究骨髓造血干细胞(HSC)移植患者早期呼吸道感染的发病情况及其与造血功能重建的关系,分析HSC移植早期呼吸道感染的危险因素。方法:回顾性病例对照研究HSC移植患者168例的临床资料,进行单因素和多因素Logistic回归分析。结果:HSC移植早期呼吸道感染率为72.6%,上呼吸道感染率为44.0%,下呼吸道感染率为28.6%。81.1%的患者呼吸道感染发生于造血功能重建前。单因素分析显示,移植早期呼吸道感染的危险因素是年龄、干细胞来源、预处理方式、非亲缘移植、人类白细胞抗原(HLA)不匹配移植和血象恢复时间,独立危险因素有年龄和非亲缘移植。上呼吸道感染单因素分析的危险因素为年龄、干细胞来源、非亲缘移植、HLA不匹配移植和血象恢复时间,独立危险因素是年龄和非亲缘移植;而下呼吸道感染的单因素分析的危险因素为干细胞来源、非亲缘移植、HLA不匹配移植和真菌性肺炎病史和发生移植物抗宿主病(GVHD),独立危险因素为HLA不匹配移植和真菌性肺炎病史。结论:HSC移植早期呼吸道感染率较高,独立危险因素有年龄、非亲缘移植、HLA不匹配移植和真菌性肺炎病史。     

G-CSF促进造血干细胞移植后造血重建的作用观察

12例接受造血干细胞移植治疗的重型 β地中海贫血患儿 ,年龄从 2 5岁～ 11 5岁 ,男 8例 ,女 4例。其中脐血移植 (UCBT) 8例 ,外周血干细胞移植 (PBSCT) 4例。病人以配对方法分为 2组进行观察。A组病人于移植后 1天起用 (8～10 ) μg/kg·dG -CSF(格兰诺赛特 ) ,B组则于移植后 5天起使用 ,剂量同上。A组患者获得的有核细胞 (NC)UCB平均为 8 2× 10 7/kg ,PBSC 5 1× 10 8/kg ;B组相对为 5 8× 10 7/kg和 12 5× 10 8/kg。两组的预处理方法基本相同 ,包括马利兰 (14～ 2 0 )mg/kg ,环磷酰胺 (16 0～ 2 0 0 )mg/kg和抗淋巴细胞球蛋白 (90～ 110 )mg/kg。 8例加马法兰 90mg/m2 ,另 2例改为噻替哌 6mg/kg和氟达拉宾 15 0mg/m2 。两组的植入例数均为 5例 ,脱地贫状态生存均为 4例。但中性粒细胞 (ANC)≥ 0 5× 10 9/L时间A组为13 3天 ,B组为 17 9天 ;血小板计数 (PLT) >2 0× 10 9/L时间A组为 2 2天 ,B组为 5 1天 ;植入后不依赖红细胞输注的时间A组(n =4)为 15 5天 ,B组 (n =4)为 44天。两组在重建造血前均发生了感染。G -CSF具有促进造血干细胞移植后造血重建的作用     

造血干细胞移植临床治疗进展

造血干细胞移植 (HSCT)是近 2 0多年发展起来的医疗技术 ,与众多的基础科学相关。在我国 ,由于每年约有 3～ 4万人患上白血病 ,而希望通过移植来根治该病的理论学说和实际临床操作尚存在许多待研究的问题。主要表现在 HSCT后 ,疾病转变无法准确预测 ,影响因素复杂 ,包括对机体产生的正、负影响的双重效应。在这种利弊共存的体内环境中 ,有效控制 HSCT之后产生的危害性 ,对提高机体抗疾病的免疫能力具有极重要的临床意义。本文拟综述从细胞和分子水平分析造血干细胞成分与受体免疫系统之间的免疫反应。1　免疫耐受性作用移植物抗宿主疾…     

Pulmonary complications after hematopoietic stem cell transplantation

Despite advanced effective prophylaxes, pulmonary complications still occur in a high proportion of all hematopoietic stem cell recipients, accounting for considerable morbidity and mortality. The aim of our study was to describe the causes, incidences and mortality rates secondary to pulmonary complications and risk factors of such complications following hematopoietic stem cell transplantation (HSCT). We reviewed the medical records of 287 patients who underwent either autologous or allogeneic HSCT for hematologic disorders from February 1996 to October 2003 at Samsung Medical Center (134 autografts, 153 allografts). The timing of pulmonary complications was divided into pre-engraftment, early and late period. The spectrum of pulmonary complications included infectious and non-infectious conditions. 73 of the 287 patients (25.4%) developed pulmonary complications. Among these patients, 40 (54.8%) and 29 (39.7%) had infectious and non-infectious conditions, respectively. The overall mortality rate from pulmonary complications was 28.8%. Allogeneic transplant, grade II-IV acute graft-versus-host disease (GVHD) and extensive chronic GVHD were the risk factors with statistical significance for pulmonary complications after HSCT. The mortality rates from pulmonary complications following HSCT were high, especially those of viral and fungal pneumonia, diffuse alveolar hemorrhage and idiopathic pneumonia syndrome.     

Pre-engraftment syndrome in hematopoietic stem cell transplantation

The clinical findings of fever and skin rash with or without evidence of fluid retention, which mimic engraftment syndrome, have been observed during the pre-engraftment period in patients undergoing hematopoietic stem cell transplantation. In order to characterize this newly observed clinical syndrome called pre-engraftment syndrome (pES), we retrospectively analyzed the clinical records of 50 patients. Three out of 14 patients (23.1%) who underwent cord blood stem cell transplantation developed non-infectious fever, skin rash, and tachypnea 4-15 days prior to neutrophil engraftment. Two patients spontaneously recovered with fluid restriction and oxygen inhalation. One patient died of a complicated pulmonary hemorrhage in spite of aggressive supportive therapy and steroid treatment. Four out of 23 patients (17.4%) who underwent allogeneic bone marrow transplantation developed non-infectious fever and skin rash 4 to 5 days prior to neutrophil engraftment. All four of these patients recovered with only steroid treatment. These characteristic findings were not observed in patients who had undergone autologous peripheral blood stem cell transplantation. Interestingly, the speed of neutrophil engraftment was significantly faster for the patients suffering from pre-engraftment syndrome. The close observation and further pathophysiological research are required to better understand this syndrome.     

广谱抗菌药物防治造血干细胞移植后的早期感染

BACKGROUND:Occurrence of acute graft-versus-host disease after hematopoietic stem cell transplantation is closely related to early infection, so controlling infection can decrease the transplant- related mortality. OBJECTIVE:To explore effects of broad-spectrum antibiotics on the occurrence of early infection after hematopoietic stem cell transplantation. METHODS:Clinical data of 31 patients undergoing autologous peripheral blood stem cell transplantation were collected. Within 30 days after cell transplantation, occurrence rate and types of early infection were detected and recorded. Besides, distribution of pathogens, as well as treatment and outcome of patients were statistically observed. RESULTS AND CONCLUSION:All patients successfully underwent hematopoietic stem cell transplantation, and the occurrence rate of infection was 71% with no death at early stage after cell transplantation. Twenty strains of pathogens were detected, in which gram-negative bacteria accounted for 80%. In addition, there was a significant negative correlation between the number of neutrophils in the peripheral blood and the duration of infection (P < 0.01). These results indicate that the infection rate at early stage after hematopoietic stem cell transplantation is relatively higher, which is associated with reduction and recovery time of neutrophils. Therefore, it is advisable to choose appropriate broad-spectrum antibiotics for preventive treatment at early stage after cell transplantation, so as to quickly and effectively control infections.     

Clinical characteristics and outcomes of posttransplant lymphoproliferative disorders following allogeneic hematopoietic stem cell transplantation in Korea

Between 1995 and 2003, seven cases of posttransplant lymphoproliferative disorder (PTLD) were identified among 1,116 patients who received allogeneic hematopoietic stem cell transplantations (HSCT) at Catholic HSCT Center (overall incidence 0.6%). Five (71.4%) patients had episodes of acute graft-versus-host-disease (GVHD) and were treated with steroids. Cervical lymphadenopathy was observed in most cases (71.4%), but clinical symptoms varied depending on the involved sites. Pathologic findings varied: 1 case of plasmacytic hyperplasia, 3 of polymorphic PTLD, 2 of diffuse large B-cell lymphoma, 1 of large T-cell lymphoma, which proved to be associated with Epstein-Barr virus (EBV). The proportion of EBV-negative PTLD was 33.3%. Five patients demonstrated a good response to treatment (treatment response rate 71.4%). The overall mortality was 42.8%, and one death was directly attributable to PTLD. The incidence of PTLD is expected to increase, based on the rising use of grafts from alternative donors and recent clinical features of PTLD manifested by a disseminated and fulminant nature. It is necessary to have a high level of suspicion when monitoring patients and readily adopt prompt and effective cellular immunotherapy for PTLD.     

Hematopoietic stem cell transplantation in children with leukemia: a single institution experience with respect to donors

Aim of this study was to compare the outcomes of transplantation by donor source and to help select the best alternative donor in children with leukemia. Donor sources included matched related donor (MRD, n = 35), allele-matched unrelated donor (M-UD, n = 10) or -mismatched (MM)-UD (n = 13) or unrelated umbilical cord blood (UCB, n = 11). UCB group had a significantly higher incidence of grade II-IV acute graft versus host disease (MRD, 11.8%; M-UD, 30.0%; MM-UD, 15.4%, UCB, 54.4%, P = 0.004) but there was no difference in incidence of chronic graft versus host disease between 4 groups. The 5-yr leukemia-free survival (LFS) was 76.7%, 60.0%, 69.2%, and 45.5%, respectively (P = 0.128). MRD group showed higher LFS rate than UCB group (P = 0.022). However, LFS of M-UD and MM-UD together (65.2%) was not different from that of MRD group (76.7%, P = 0.325), or from that of UCB (45.5%, P = 0.190). The relapse incidence at 5 yr was 17.1%, 20.0%, 15.4%, and 0%, respectively (P = 0.460). The 100-day treatment-related mortality was 2.9%, 20.0%, 7.7%, and 36.4%, respectively (P = 0.011). Despite the limitations of small number of patients, unrelated donor transplants including even allele-mismatched ones, seem to be as effective in children with leukemia lacking suitable relative donors. Also, UCB transplant may serve as another possible option in urgent transplants.     

骨髓间充质干细胞在致敏与非致敏BALB/c小鼠造血干细胞移植中的应用

背景：造血干细胞移植对多种疾病具有治疗作用,但其取材不便,且细胞数量受年龄限制等原因,故而应用具有一定局限性。 目的：探索骨髓间充质干细胞在致敏与非致敏BALB/c小鼠造血干细胞移植中的应用价值。 方法：将BALB/c小鼠骨髓细胞在体外进行分离,采用贴壁培养的方法获得间充质干细胞,使用流式细胞仪对细胞表面的分子标记进行检测。应用异基因脾细胞输注方法建立致敏动物模型,用绿色荧光染料标记骨髓间充质干细胞,分别移植到致敏和非致敏的受体小鼠体内,并在移植后的不同时间点对间充质干细胞的归巢情况进行检测。对致敏BALB/c小鼠进行照射预处理,联合应用异基因骨髓细胞与同基因间充质干细胞移植,观察BALB/c小鼠的生存情况。 结果与结论：移植48 h后,间充质干细胞在致敏受体和非致敏受体小鼠分别归巢于脾脏和骨髓。在造血干细胞的移植实验中,致敏BALB/c小鼠接受异基因骨髓细胞与同基因骨髓间充质干细胞联合移植,结果显示致敏BALB/c小鼠全部在移植后12-15 d死亡,生存的中位时间是14 d,而仅接受异基因骨髓细胞移植的致敏BALB/c小鼠的中位生存时间为13 d。说明细胞移植后在致敏受体内间充质干细胞主要归巢为脾脏和骨髓,联合应用间充质干细胞移植对异基因造血干/祖细胞植入致敏受体体内并没有起到有效的促进作用。 中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

减低剂量预处理方案在亲缘HLA单倍体相合造血干细胞移植中的应用

背景：近年来减低剂量预处理异基因造血干细胞移植已被证明是安全有效的治疗手段,在同胞全相合和无关供者中应用逐年增多,它特别适合老年人或年轻人合并器官功能障碍的患者,然而由于找到HLA配型相合供体的概率不高,使得同胞全相合和无关供者减低剂量预处理异基因造血干细胞移植开展受限,而HLA不相合/单倍体供体则可以迅速找到,但减低剂量预处理的单倍体造血干细胞移植应用的报道还较少,国内尚未见报道,因此对减低剂量预处理的单倍体造血干细胞移植的开展情况进行综述非常重要。 目的：综述减低剂量预处理在亲缘HLA单倍体造血干细胞移植中的应用现状。 方法：以“减低剂量预处理方案、非清髓性预处理方案、HLA单倍体相合、造血干细胞移植和No-nmyeloablative  conditioning,Reduced-intensity conditioning,HLA-haploidentical,Hematopoietic stem cell transplantation”为检索词,应用计算机检索1997至2014年万方数据库、CNKI和PubMed数据库、外文医学信息资源检索平台检索关于减低剂量预处理在亲缘HLA单倍体造血干细胞移植中应用的相关文献,根据纳入标准和排除标准,最终选取25篇文献进行分析,全部为英文。 结果与结论：减低剂量预处理异基因造血干细胞移植在HLA同胞全相合及无关供者中开展的较多且效果愈来愈好。减低剂量预处理的单倍体造血干细胞移植开展的较晚且报道较少,其植入、感染、移植相关死亡、移植物抗宿主病、长期无病生存率和总生存率等各个研究的结果差异较大,早期结果稍差,而近期总体情况有明显改善。目前看减低剂量预处理的单倍体造血干细胞移植是可行的,尤其对于找不到同胞相合及无关全相合供者的患者来说,HLA单倍体相合的血缘关系亲属成为最有潜力的干细胞来源。减低剂量预处理的单倍体造血干细胞移植保留较强的移植物抗白血病效应,且寻找供者容易,有足够的细胞后续治疗如供者淋巴细胞输注,同时通过发挥移植物抗白血病效应,可有效清除患者体内的肿瘤细胞,为处在疾病进展期或经历多次治疗失败的患者,尤其是老年患者、合并器官功能障碍及并发症患者,提供有效的挽救治疗手段。但由于开展的时间较短,今后在应用中该如何选择最佳方案、最佳时机以及减低移植物抗宿主病、移植相关死亡率及复发率等尚需进一步深入的研究。中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程全文链接：     

自体造血干细胞移植治疗外周T细胞淋巴瘤

背景：外周T细胞淋巴瘤亚洲地区发病率高,具有侵袭性,预后普遍较差,目前尚无标准治疗策略。 目的：评价自体造血干细胞移植治疗外周T细胞淋巴瘤的疗效及毒副反应。 方法：回顾性分析2003年3月至2014年4月行自体造血干细胞移植治疗外周T细胞淋巴瘤35例,包括结外NK/T细胞淋巴瘤鼻型22例,血管免疫母细胞T细胞淋巴瘤1例,外周T细胞淋巴瘤(非特殊型)8例,间变性大T细胞淋巴瘤 ALK(+)3例,ALK(-)1例;所有病例均按WHO 2001年和WHO 2008年分类进行病理分型,均采用VAEMMC+全射照射预处理方案。 结果与结论：随访中位时间54个月(9-120个月),28例患者(80%)存活,其中无病存活25例(71%),8例(23%)复发,其中7例死亡,1例尚在治疗中。近期毒性主要为骨髓造血受抑,无明显远期并发症。结果表明自体造血干细胞移植治疗外周T细胞淋巴瘤安全有效,早期(第1次完全缓解)行移植疗效佳。 中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程全文链接：     

The risk of cytomegalovirus infection in non-myeloablative peripheral stem cell transplantation compared with conventional bone marrow transplantation

Non-myeloablative allogeneic peripheral stem cell transplantation (NST) is a novel therapeutic strategy for patients with hematologic malignancies. Whether non-myeloablative transplants are associated with increased risk of cytomegalovirus (CMV) infections is unknown. To clarify this issue, we compared the outcome of CMV infection following 24 allogeneic non-myeloablative peripheral blood stem cell transplants and 40 conventional bone marrow transplants (CBT). The NST regimen consisted (mg/kg). Twelve patients (50%) in the NST group and 17 (43%) in the CBT group developed positive antigenemia before day 100 (p=0.60). The time to the first appearance of positive antigenemia was not different between these two groups (p=0.40), and two groups showed similar initial and maximal antigenemia values (p=0.56 and p=0.68, respectively). Only one case of CMV colitis developed in the CBT group whereas CMV disease did not develop in the NST group. Although statistically insignificant, the treatment response against CMV antigenemia using ganciclovir was in favor of NST group. In conclusion, there was no difference in the risk of CMV infection between NST group and CBT group. Further prospective and controlled study is needed to clarify the impact of non-myeloablative procedure on the outcome of CMV infection.