造血干细胞移植并发症的防治

目前,我国造血干细胞移植（HSCT）正处于飞速发展阶段,但移植后各种并发症仍然是阻碍受体及造血干细胞存活的重要原因.因此,重视HSCT后并发症十分重要.……     

造血干细胞移植的肺部并发症

造血干细胞移植(HSCT)目前已广泛应用于临床,为血液系统肿瘤及实体肿瘤,免疫性及遗传性疾病患者带来了生存的希望.但HSCT术后肺部并发症时常发生.本文就HSCT术后可能发生的肺部并发症的发病因素、诊断及治疗方面作一综述.     

造血干细胞移植后中枢神经系统并发症的临床研究

目的 探讨造血干细胞移植(HSCT)后中枢神经系统(CNS)并发症的发生率影响因素及预后,提高CNS并发症的诊断和治疗水平,从而改善此类患者的生存.方法 研究对象为自2001年5月至2007年12月在北京市道培医院行HSCT的640例患者,对其中发生CNS并发症患者的临床特点进行回顾性分析和研究.结果 640例HSCT患者中共57例发生了CNS并发症,发生率为8.9%.非血缘、单倍型和间胞相合HSCT后CNS并发症的发生率分别为12.0%(10/83),13.5%(39/289)和3.4%(8/237)(P<0.001).预处理为全身照射(TBI)和非TBI方案的发生率分别为19.4%(7/36)和8.3%(50/604)(P=0.047).年龄<14岁组和年龄≥14岁组的发生率分别为15.3%(9/59)和8.3%(48/581)(P=0.072).恶性疾病中的发病率为8.9%(56/627),非恶性疾病中的发病率为7.7%(1/13)(P=1.000).最常见的并发症为原发病复发和颅内感染.患者总体病死率为57.9%(33/57),其中66.7%(22/33)的患者死亡原因为CNS并发症.结论 单倍型和非血缘移植、TBI的预处理方案是移植后发生CNS并发症的高危因素.而年龄和原发病类型对CNS并发症的发病率无显著影响.早期诊断和积极有效地治疗CNS并发症可以降低其相关病死率,改善患者的预后.     

造血干细胞移植后肺部感染性并发症

造血干细胞移植现已广泛应用于临床,为血液系统肿瘤及实体器官肿瘤患者提供了希望。但移植后感染性并发症很常见,尤其肺部感染更具较高的发病率和死亡率。本文综述了造血干细胞器官移植后肺部感染性并发症的特点及治疗,旨在为临床工作提供帮助。     

造血干细胞移植后的中枢神经系统并发症及防治

造血干细胞移植（HSCT）已成为治疗造血系统、遗传及代谢性、自身免疫性等疾病的重要方法之一。随着移植技术的进步,患者的生存率逐步提高,移植后的并发症也逐渐引起人们的重视。临床研究显示11％～59％的患者在移植后会发生中枢神经系统并发症,     

造血干细胞移植后出血并发症的临床分析

出血是造血干细胞移植（HSCT）后早期常见并发症，严重出血是移植患者早期死亡的重要原因之一。为探讨出血并发症的临床特征及其对HSCT患者生存率的影响，现将我院1994年5月至2006年4月139例HSCT患者的出血并发症分析如下。     

造血干细胞移植后肺部非感染性并发症

造血干细胞移植现已在临床上广为应用,移植后肺部非感染性并发症的发生率和死亡率较高,已受到广泛关注。本文综述了造血干细胞移植后的多种肺部非感染性并发症的特点,以期为临床工作提供帮助。     

造血干细胞移植后早期患结核感染二例

据文献报道，近几年我国的结核病发病率有逐年增多的趋势［1］虽然造血干细胞移植后的恢复期可出现多种并发症，但合并结核感染者较为少见。我院2例分别于移植后十12d和十49d出现结核感染，现报告如下。1病例介绍例1女，25岁，因ANLL－M2于1997年7月1日行HLA半相合混合骨髓移植治疗。预处理方案：TBI5．5GY，肺部5．0GY，VCR2mg，Ara－C500mg，VP16100mg，Mit10mg，CTX2200mg，术后于7月13日出现寒战，高热，T39．OC～40．OC，右下胸部针刺样疼痛，无咳嗽、咳痰，血培养，痰培养，口腔、皮肤、肝周、耳、鼻拭子培养均阴性。血…     

干细胞移植与心血管疾病

干细胞是一类具有自我复制和分化潜能的早期未分化细胞。本综述着重介绍干细胞移植技术在基础及临床心血管领域的研究现况 ,并对干细胞技术的进一步临床应用前景作了初步讨论     

肾脏疾患的造血干细胞移植

用造血干细胞移植治疗肾细胞癌及非恶性难治性肾脏疾病是近年开展起来的一种新治疗方法。但造血干细胞移植对肾脏的毒副作用也较大，造血干细胞移植相关肾病逐渐引起了人们的重视。本文就造血干细胞移植在肾脏疾病中的应用进展及其移植后的肾性并发症作一综述。     

Gastrointestinal and hepatic complications of hematopoietic stem cell transplantation

Recognition and management of gastrointestinal and hepatic complications of hematopoietic stem cell transplantation has gained increasing importance as indications and techniques of transplantation have expanded in the last few years. The transplant recipient is at risk for several complications including conditioning chemotherapy related toxicities, infections, bleeding, sinusoidal obstruction syndrome, acute and chronic graft-versus-host disease (GVHD) as well as other long-term problems. The severity and the incidence of many complications have improved in the past several years as the intensity of conditioning regimens has diminished and better supportive care and GVHD prevention strategies have been implemented. Transplant clinicians, however, continue to be challenged with problems arising from human leukocyte antigen-mismatched and unrelated donor transplants, expanding transplant indications and age-limit. This review describes the most commonly seen transplant related complications, focusing on their pathogenesis, differential diagnosis and management.     

Prolonged immune deficiency following allogeneic stem cell transplantation: risk factors and complications in adult patients

To evaluate the long-term immune reconstitution after allogeneic haematopoietic stem cell transplantation (SCT), we prospectively screened standard immune parameters in a series of 105 patients, at a median time of 15 months after SCT. Analysing lymphoid phenotypes, in vitro immune functions and immunoglobulin levels, we found that, more than 1 year post SCT, cellular and humoral immunity was still altered in a significant number of patients. CD4+ T cells were < 200/microl in one third of patients, and the CD4/CD8 ratio was still reversed in 78% of patients. Almost all patients showed positive T-cell responses against mitogens, but antigen-specific proliferation assays identified 20% to 80% of non-responders. B-cell counts were reconstituted in 61% of the patients, but levels of total immunoglobulins were still low in 59%. In multivariate analyses, human leucocyte antigen (HLA) disparity between donor and recipient and chronic graft-versus-host disease were the leading causes affecting immune reconstitution. Interestingly, cytomegalovirus (CMV) infections were strongly associated with normal CD8+ T-cell counts. Studying the impact of impaired immune reconstitution on the rate of infections occurring in the 6 years following screening, we identified three parameters (low B-cell count, inverted CD4/CD8 ratio, and negative response to tetanus toxin) as significant risk factors for developing such late infections.     

Low,fixed dose defibrotide in management of hepatic veno-occlusive disease post stem cell transplantation

Objective/background

Hepatic veno-occlusive disease (VOD) is well recognized potentially serious regimen-related toxicity seen after stem cell transplantation. Severe VOD is associated with poor long-term outcomes with very high mortality. Besides supportive care, only defibrotide has been found to be effective in the management of VOD. The recommended dose of defibrotide is 25 mg/kg/d but there has been no classical dose finding study done for this drug. A higher dose of defibrotide is associated with increased risk of bleeding and this drug is prohibitively expensive. We report our experience of using fixed low dose of defibrotide in patients with VOD.

更昔洛韦胶囊在造血干细胞移植患者巨细胞病毒血症中的应用

目的 探讨更昔洛韦(ganciclovir,DHPG)胶囊治疗造血干细胞移植(HSCT)后患者巨细胞病毒(CMV)血症的疗效和安全性.方法 选择2006年2月至5月在北京大学血液病研究所行HSCT的30例移植后CMV血症患者进行前瞻性研究.CMV感染预防采用更昔洛韦10 mg/(kg·d),分2次静脉滴注,移植前第9天至移植前第2天,连续8 d.移植后应用定量多聚酶链反应(PCR)定期进行病毒DNA检测,CMV-DNA定量＞6.0×102拷贝/mL或＜1×105拷贝/mL的患者应用更昔洛韦胶囊1 g每日3次治疗.结果 HSCT后发生CMV血症的中位时间为移植后42 d,诊断时CMV-DNA中位数4.626×103拷贝/mL.更昔洛韦胶囊治疗的总有效率为90%,14 d转阴率66.67%,转阴中位时间10 d.4例(13.3%)出现不良事件,程度为轻至中度,表现为血细胞计数减少3例,转氨酶升高1例.结论 更昔洛韦胶囊用于治疗HSCT后CMV血症患者安全有效.     

Hyperthyroidism as a latent complication of autologous hematopoietic stem cell transplantation

Thyroid dysfunction after hematopoietic stem cell transplantation has been investigated in many studies. Most post-transplant thyroid disorders such as hypothyroidism are recognized as a late complication whilst hyperthyroidism is infrequent and transient, and usually happens early at the onset after transplant. Here, we report two rare hyperthyroid cases, developing more than 2 years after autologous stem cell transplant. We suggest that hyperthyroidism be alerted in the post-transplant care, and special attention be paid to any latent events.     

Advances in stem cell mobilization

The use of mobilized peripheral blood stem cells (PBSCs) has largely replaced the use of bone marrow as a source of stem cells for both allogeneic and autologous stem cell transplantation. G-CSF with or without chemotherapy is the most commonly used regimen for stem cell mobilization. Some donors or patients, especially the heavily pretreated patients, fail to mobilize the targeted number of stem cells with this regimen. A better understanding of the mechanisms involved in hematopoietic stem cell (HSC) trafficking could lead to the development of newer mobilizing agents and therapeutic approaches. This review will cover the current methods for stem cell mobilization and recent developments in the understanding of the biology of stem cells and the bone marrow microenvironment.     

Infectious complications following nonmyeloablative allogeneic hematopoietic stem cell transplantation

Abstract: Nonmyeloablative hematopoietic stem cell transplantation (NST) has been explored in hematological malignancies and solid tumors in an attempt to minimize treatment‐related toxicity. Whether this approach is associated with reduced risk of infectious complications is unclear. The aim of the current study was to evaluate the infectious complications in a series of 32 consecutive adult patients who received NST at our institution. Peripheral blood stem cell grafts (n=30) or marrow grafts (n=2) were infused from human leukocyte antibody (HLA)‐matched sibling (n=30), partially matched related (n=1), or unrelated (n=1) donors. Neutropenia developed in two‐thirds of patients and lasted 16 days. Acute graft‐versus‐host disease (GVHD) grade II to IV was observed in 25% of patients, whereas 35% of patients had signs of extensive chronic GVHD. Twenty‐two patients (69%) had at least one significant infectious episode. Bacteremia occurred in 19% of patients (n=5 gram‐positive, n=1 gram‐negative microorganisms). Cytomegalovirus (CMV) infection was observed in 10 out of 28 (36%) evaluable patients; 4 of these had recurrent or persistent CMV antigenemia requiring a second‐line treatment, but eventually the viremia cleared. No patients experienced CMV disease. Fungal infections were documented in five (16%) patients, comprising invasive fungal infections in two cases and mucosal fungal infections in three. Four patients died of transplant‐related causes, and three of these died before day +100. Infection was considered the primary cause of death in one patient (pulmonary aspergillosis) and contributed to death in another two. The actuarial probability of nonrelapse mortality at 100 days was 10% (95% confidence interval, 3–26%). Our preliminary results suggest that NST is associated to a low incidence of bacteremia or fungal and viral infections. Whether these findings would translate into an improved overall survival needs to be confirmed in larger prospective studies.     

生物学制剂和干细胞移植治疗炎症性肠病的进展

炎症性肠病（IBD）是一种病因复杂的肠道慢性炎症性疾病。治疗IBD的传统药物虽能控制症状,但多数患者反复发作迁延不愈。新近研究的生物学制剂、干细胞移植等疗法已逐渐用于临床,较传统药物凸显出一定的优势,成为近年来IBD治疗学的研究热点,该文就此两种新疗法进行概述。