非亲缘供者异基因造血干细胞移植治疗恶性血液病15例

背景：异基因造血干细胞移植是治愈恶性血液病的主要方法,但中国多为单子女家庭,因此探索非亲缘供者异基因造血干细胞移植的治疗效果及并发症防治具有重要的意义。目的：观察非亲缘供者异基因造血干细胞移植治疗15例恶性血液病的疗效和相关并发症。方法：15例恶性血液病患者接受非血缘关系异基因造血干细胞移植治疗。所有患者均采用经典或改良的马利兰联合环磷酰胺预处理方案。4例采用环孢素A＋短程甲氨蝶呤＋麦考酚吗乙酯预防移植物抗宿主病,另11例患者同时加用抗胸腺细胞球蛋白。输注供者有核细胞中位数为6.3×108/kg,CD34＋细胞中位数为3.1×10^6/kg。结果与结论：除1例移植后早期死亡不能评估外,其余14例经检测均证实植活。发生急性移植物抗宿主病Ⅰ度5例,Ⅱ、Ⅲ、Ⅳ度各1例;慢性局限性移植物抗宿主病8例。发生肺部真菌感染5例,巨细胞病毒病毒血症3例,带状疱疹病毒感染2例,出血性膀胱炎6例。15例患者中目前无病存活10例,生存期为5个月~11年。结果提示非血缘关系异基因造血干细胞移植是安全且可行的,治疗恶性血液病疗效良好,降低移植相关并发症已成为非血缘关系异基因造血干细胞移植需解决的首要问题。

Transplantation of unrelated allogeneic hematopoietic stem cells for treatment of malignant hematological diseases in 15 cases

BACKGROUND： Allogeneic hematopoietic stem cells transplantation is the main method to cure malignant hematological diseases. As there are many single child families in China, it is important to explore the therapeutic efficiency of unrelated allogeneic hematopoietic stem cells transplantation and prevent the complications after surgery. OBJECTIVE： To observe the therapeutic efficiency and associated complications of unrelated allogeneic hematopoietic stem cells transplantation for treatment of malignant hematological diseases in 15 cases. METHODS： Fifteen patients with malignant hematological diseases received. All cases were subjected to busulfan combined with cyclophosphamide regimen. The graft-versus-host disease was prevented by cyclosporin A, short-term methotrexate and mycophenolate mofetil regimen in 4 cases, and the other 11 cases received antithymocyte globulin additionally. Patients were infused by the nucleated cells with median of 6.3×108/kg and the CD34＋ cells with median of 3.1×10^6/kg. RESULTS AND CONCLUSION： Fourteen cases had been identified to achieve engraftment, and 1 case died at early stage. Five cases developed grade Ⅰ acute graft-versus-host disease, and three cases developed grade Ⅱ, Ⅲ and Ⅳ acute graft-versus-host disease respectively. Eight patients experienced local chronic graft-versus-host disease. Five cases suffered fungal infection in lung, three had cytomegalovirus infection and six developed hemorrhagic cystitis. 10 cases have lived for 5 months to 11 years after transplantation. Unrelated allogeneic hematopoietic stem cells transplantation is safe and can be tolerant well for patients. Reducing the high transplantation-related mortality is the first problem needs to be overcome.