HLA单倍体与全相合外周血干细胞移植后免疫功能重建与并发症的比较

目的 初探HLA单倍体相合与全相合异基因外周血干细胞移植(allo-PBSCT)后两组患者细胞免疫功能差异及其与主要并发症的关系.方法 选择2004年6月一2007年12月在新疆医科大学第一附属医院接受allo-PBSCT的67例患者,其中33例接受全相合,34例接受单倍体相合移植.采用间接免疫荧光法前瞻性检测移植前、后1、3、6、12及18个月两组患者的淋巴细胞亚群,同时检测100例正常对照.统计分析两组患者移植后免疫功能的重建情况及其与主要并发症的关系.结果 (1)67例患者与正常对照组比较,移植后1个月CD_3~+、CD_4~+、CD_4~+/CD_8~+、3个月CD_4~+、CD_4~+/CD_8~+及6个月CD_4~+均低于正常对照组,移植后3个月及6个月CD_4~+高于正常对照组.(2)单倍体与全相合患者移植后免疫功能比较差异无统计学意义(P>0.05).(3)单倍体移植重症感染与未感染患者免疫功能比较差异无统计学意义(P>O.05).(4)发生慢性移植物抗宿主病(cGVHD)与未发生cGVHD的两组患者间免疫功能比较差异均无统计学意义(P>0.05).(5)8例复发患者与未复发患者免疫功能差异无统计学意义(P>0.05).结论 应用含抗胸腺淋巴细胞球蛋白多种免疫抑制剂进行非体外去T细胞的PBSC单倍体移植,与常规方案进行HLA相合的PBSC移植相比,两组患者移植后的免疫功能重建总体无明显差异,移植后两组患者的重度感染率、白血病复发率及移植相关病死率差异也无统计学意义,提示单倍体移植方案是安全有效的.

Comparison of immunological reconstitution and related complications after HLA-matched and HLA haploidentical peripheral blood hemtopoiefic stem cell transplantation

Objective To explore the difference of immune function and relationship with main complications after HLA-matched and HLA haploidentical allogeneic peripheral blood hematopoietic stem cell transplantation (allo-PBSCT). Methods Sixty-seven patients undergoing HLA-matched (n=33) or HLA haploidentical (n=34) allo-PBSCT during the same time period in our hospital from June 2004 to December 2007 were included in this study. Indirect immunofluorescence assay was employed to detect lymphocyte subsets before transplantation and on month l, 3, 6, 12 and 18 after transplantation and the lymphocyte subsets of 100 healthy people were used as normal control. The comparison of immunological reconsfitution and relationship with main complications was carried out with statistical analysis. Results (1) Comparison of the 67 patients with normal controls showed that CD_3~+, CD_4~+, CD_4~+/CW_8~+ at month 1, CD_4~+, CD_4~+/CD_8~+ at month 3 and CD_4~+ at month 6 after PBSCT were lower. CD_8~+ at month 3 and month 6 were higher. (2) The immune function was not statistically different between HLA haploidentical and HLA-matched allo-PBSCT (P>O.05). (3) The immune function of patients with and without severe infection was not statistically different (P>0.05). (4) The immune function of patients with chronic graft-versus-host disease (cGVHD) between HLA haploidentical and HLA-matched allo-PBSCT groups was not statistically different. The immune function of patients without cGVHD in two groups was not statistically different (P>0.05). (5) The immune function of patients with or without relapse was not statistically different (P>0.05). Conclusions HLA-haploidentical PBSCT conditioning including antithymocyte globulin without in vitro T cell depletion is feasible and safe. The immunological reconstitution, incidence of severe infection, incidence of relapse and treatment-related mortality are not significantly different between HLA matched and HLA-haploidentical allo-PBSCT.