预处理方案中加抗胸腺细胞球蛋白减少异基因造血干细胞移植慢性移植物抗宿主病

目的　观察预处理方案中加入抗人胸腺细胞球蛋白 (ATG)对异基因造血干细胞移植慢性移植物抗宿主病 (cGVHD)和生存质量的影响。方法　将接受干细胞移植的患者分成研究组和治疗组 ,研究组在FBC预处理方案 (氟达拉宾、白消安、环磷酰胺 )基础上加中剂量的ATG ,对照组仅用FBC预处理方案 ,观察两组植入率 ,急、慢性GVHD的发生率及其程度。结果　研究组 19例患者接受单个核细胞 (MNC)为 6× 10 8/kg [(3.0～ 9.0 )× 10 8/kg],其中CD34 细胞为 5 .5× 10 6 /kg[(3.0～ 6 .5 )× 10 6 /kg],18例完全供者植入 ,中性粒细胞 (ANC) >5 0 0 μl平均时间为 13d ,6例 (31.5 % )发生急性GVHD(aGVHD) ;平均随访 2 5 0d(15 0～ 4 90d) ,7例 (35 .3% )发生cGVHD ,14例生存患者Karnofsky >90分。对照组 2 4例平均输入供者MNC 5 .5× 10 8/kg [(4.5～ 7.5 )× 10 8/kg],其中CD34 细胞数为 5 .0× 10 6 /kg[(3.0～ 7.0 )× 10 6 /kg],ANC >5 0 0 μl平均时间为 12d ,2 3例完全供者植入 ,9例发生Ⅰ～Ⅱ度aGVHD ,6例发生Ⅲ～Ⅳ度aGVHD ,aGVHD发生率为 6 2 .5 % ;平均随访 4 4 0d(30 0～ 10 95d) ,19例 (79.2 % )发生cGVHD ,仅 4例生存患者Karnofsky>90分 ,统计学处理表明两组有显著性差异。结论　FBC预处理方案中加入中剂量

Decrease of chronic graft-versus-host disease by adding anti-human thymocyte globulin to the conditioning regimen

OBJECTIVE: To observe the influence of adding anti-human thymocyte globulin (ATG) into conditioning regimen on graft-versus-host disease (GVHD) and life quality of the patients of allo-peripheral blood stem cell transplantation (PBSCT). METHODS: Patients were distributed into study (19 cases) and control (24 cases) groups at random. Median dose of rabbit ATG was added to the conditioning regimen based on the fludara, busufan and cyclophosphamide (FBC) in study group, and no ATG in the control group. Acute and chronic GVHD disease and Karnofsky scores were compared between two groups after allo-PBSCT. RESULTS: The patients in the study group received a mean of 6.0 (3 - 9) x 10(8)/kg mononucleated cells and 5.5 (4.5 - 7.5) x 10(6)/kg in the control group. The mean CD(34)(+) cells number was 5.5 (3.0 - 6.5) x 10(5)/kg in the study and 5.0 (3.0 - 7.0) x 10(6)/kg in the control group respectively. Eighteen patients in the study group and in the control group were successfully engrafted. The mean time of absolute neutrophil count recovered more than 500/ micro l was 13 days and 12 days respectively. Acute GVHD occurred in 6 patients of the study group, and 15 of the control group. Seven patients suffered from chronic GVHD and 14 got 90 Kanrofsky scores in a mean of 250 days follow-up in the study group, and 19 patients GVHD and 4 patients respectively in a mean of 440 days follow-up in the control group. There was a significant difference for acute and chronic GVHD and life quality between the two groups. CONCLUSIONS: Addition of anti-thymocyte globulin to the FBC conditioning regimen had no effect on stem cells engraftment but could decrease acute and chronic GVHD and improve patients life quality.