非清髓异基因外周血造血干细胞移植后嵌合体分析

本研究旨在探讨非清髓异基因外周血造血干细胞移植(NAPBSCT)后造血嵌合体的临床意义。采用FBC(氟达拉宾+白消安+环磷酰胺)±阿糖胞苷(Ara-C)预处理方案,对28例血液病患者进行NAPBSCT,采集供者和受者术前外周血及术后不同时间段的序列血样,用STR-PCR结合聚丙烯酰胺凝胶电泳、银染色和凝胶成像分析技术半定量方法计算供体细胞嵌合率。结果显示:移植后1月,28例患者中1例移植失败,22例形成完全供者造血嵌合体(CC),5例形成混合造血嵌合体(MC);移植后7天时供者细胞即占优势(74.71%),较中性粒细胞(ANC)和血小板(Plt)的平均恢复时间均明显提前;CC组的aGVHD发生率高于MC组(P<0.05),两组cGVHD发生率无显著差异(P>0.05);1例MC患者发生早期移植排斥;CC组和MC组复发率无显著差异(P>0.05),1例在CC状态下复发。3例MC患者经早期临床干预治疗获得CC和完全缓解。结论:造血嵌合体的动态定量检测对判断早期植入,预测移植物排斥、复发和GVHD,以及指导临床干预治疗具有重要意义。

Analysis of Hematopoietic Chimerism after Non-myeloablative Allogeneic Peripheral Blood Stem Cell Tansplantation

The aim of this study was to analyze the hematopoietic chimerism after non-myeloablative allogeneic peripheral blood stem cell transplantation (NAPBSCT). 28 patients received NAPBSCT were evaluated. The conditioning regimen included FBC (fludarabine, busulphan, cyclophosphamide) +/- Ara-C. Peripheral blood was collected before and after transplantation in different periods. Semi-quantitative assessment of hematopoietic chimerism was performed by short tandem repeat-polymerase chain reaction (STR-PCR), polyacrylamide gel electrophoresis (PAGE) and silver staining, and analyzed by Image Analysis System. The results showed that on day 30 after transplantation, one patient failed to engraft, but 22 cases formed complete chimerism (CC) and 5 cases were of mixed chimerism. On day 7 after transplantation, the average percentage of donor cells was 74.71%. The time of dominance of the donor-specific allelic pattern preceded the recovery time of neutrophils and platelets. The incidence of aGVHD in group CC was significantly higher than that in group MC (P < 0.05). There was no significant difference in the incidence of cGVHD and disease relapse between group CC and group MC (P > 0.05). One patient relapsed in CC status without a transitional stage of MC. One patient with MC rejected grafts in early stage. 3 patients with MC transferred to CC and got complete remission after early implementation of therapy. It is concluded that sequential and quantitative detection of chimerism may be of great value to evaluate engraftment and to predict graft rejection, disease relapse and GVHD. Furthermore, it may provide a basis for early intervention treatment in the related complications.