造血干细胞移植治疗血液病110例疗效观察

 【摘要】　目的　观察造血干细胞移植（HSCT）治疗血液病的疗效，探讨移植相关并发症的预防及处理方法。方法　回顾性分析采用HSCT治疗的110例血液病患者临床资料。61例患者采用自体外周血造血干细胞移植（auto-PBSCT）；49例患者采用异基因造血干细胞移植（allo-HSCT）,其中，28例采用HLA全相合的同胞异基因外周血干细胞移植（allo-PBSCT），20例采用单倍体异基因骨髓+PBSCT，1例急性淋巴细胞白血病患儿采用脐带血HSCT。预处理方案：淋巴瘤患者采用BEAM方案（卡莫司汀+依托泊苷+阿糖胞苷+左旋苯丙氨酸氮芥）,白血病患者采用改良的Bu／Cy方案（羟基脲+阿糖胞苷+白消安+环磷酰胺+司莫司汀），多发性骨髓瘤患者采用大剂量左旋苯丙氨酸氮芥方案，急性再生障碍性贫血患者采用FC（氟达拉滨+环磷酰胺）+兔抗人胸腺细胞球蛋白（ATG）方案。移植物抗宿主病（GVHD）的预防采用短程甲氨蝶呤+环孢素A+吗替麦考酚酯，单倍体移植患者加ATG。结果　109例（99.1 %）患者成功获得造血重建，移植后中性粒细胞≥0.5×109／L、血小板≥20×109／L的平均天数在自体移植中分别为10 d和12 d，在异基因移植中分别为12 d和15 d；allo-HSCT中Ⅰ～Ⅲ度急性GVHD的发生率为28.6 ％（14／49），慢性GVHD的发生率为32.7 ％（16／49）。中位随访36个月（1～60个月），84例（76.4 ％）患者无病生存，其中，auto-PBSCT组45例（73.8 ％），allo-HSCT组39例（79.6 ％）；26例（23.6 ％）死亡。auto-PBSCT组16例（26.2 ％）复发死亡，2例（3.3 ％）复发，无移植相关死亡；allo-HSCT组9例（18.4 ％）复发死亡，3例（6.1 ％）复发，1例（2.0 ％）发生移植相关死亡。结论　HSCT是治疗恶性血液病安全、有效的方法，也是治疗血液病的重要手段之一。

Efficacy of hematopoietic stem cell transplantation in the treatment of 110 cases hematologic malignancies

Objective To observe the efficiency of hematopoietic stem cell transplantation to the treatment of hematological malignancies and explore prevention and treatment of the complications correlated with HSCT. Methods 110 patients with hematological malignancies which were treated by HSCT were recruited. 61 patients were treated with autologous peripheral blood hematopoietic stem cell transplantation （auto-PBSCT）, 49 patients were treated with allogeneie hematopoietie stem cell transplantation （allo-HSCT）. Among them, there were 28 patients were used by all HLA-identical sibling allo-PBSCT, 20 patients were used by haploid allogeneic bone marrow and peripheral blood stem cell transplantation, one case of acute lymphoblastic leukemia in children were treated with cord blood stem cell transplantation.Results 109（99.1%） patients acquired hemopoietic reconstruction. The median time of neutrophils ≥0.5×109/L, and platelets ≥ 20× 109/L were 10 days and 12 days in auto-PBSCT, and were 12 days and 15 days in allo-PBSCT. The incidence of I -III degree of acute GVHD （aGVHD） in allogeneic transplantation was 28.6 %（14/49）, however, the incidence of chronic GVHD （cGVHD） was 32.6 %（16/49）. The median follow-up time was 36 （1-60） months. 84 patients （76.4 %） were disease-free. Among them, 73.8 %（45/61） were in auto-PBSCT group, （79.6 %）39/49 were in allo-HSCT group. 26 patients （23.6 %） were died. There were 26.2 %（16/61） who were in auto-PBSCT group died of disease relapse, 3.3 %（2/61） had disease relapse. There was no transplant-related deaths. 18.4 %（9/49） who were in allo-HSCT group died of disease relapse, 6.1%（3/49） had disease relapse, 2.0 %（1/49） died of transplant-related deaths. Conclusion Hematopoietie stem cell transplantation is a safe and effective way for the treatment of malignant hematopathy patients, also an important mean for treatment of blood diseases.