异基因造血干细胞移植治疗骨髓增生异常综合征临床疗效分析

回顾性分析异基因造血干细胞移植(Allo-HSCT)治疗骨髓增生异常综合征(MDS)的适应证、治疗时机、移植物的选择、移植预处理方案的选择和移植疗效。22例患者中21例获得造血重建,1例非血缘脐血移植(UCBT)未获得植入的成人患者,于非血缘脐血移植(UCBT)后38 d进行母亲HLA4/6相合的外周血联合骨髓造血干细胞移植解救治疗获得植入。22例中死亡3例,无1例复发。MDS患者何时进行Allo-HSCT需依据国际预后积分系统(IPSS)对患者分组,评分属于高危组的患者宜在疾病确诊后尽早进行移植,而低危组的患者可在其他药物治疗效果不佳的时候进行;不仅可选择血缘关系的骨髓移植(BMT)和外周血造血干细胞移植(PBSCT),也可进行非血缘人类白细胞共同抗原(HLA)不全相合的UCBT;移植预处理如采用减低强度的方案(RIC)并不影响移植效果。

Clinical efficacy of allogeneic hematopoietic stem cell transplantation on myelodysplastic syndrome

The aim of the study was to analyze retrospectively the indication and timing of transplantation,choice of hematopoietic stem cell source,preparative regimens for treating myelodysplastic syndrome(MDS) by allogeneic hematopoietic stem cell transplantation(Allo-HSCT) and its efficacy.Details of myeloid recovery were available from 21 patients,only one adult patient failed to have engraftment in the first transplantation with unrelated cord blood,but obtained hematopoiesis recovery by 4 /6 HLA-matched related peripheral blood stem cell transplantation(PBSCT) combined with bone marrow transplantation(BMT) from her mother in thirty-eight days.Three patients died at median time of 13 months after transplantation,but none of 22 patients relapsed.When to proceed HSCT for MDS patients is dependent on international prognostic scoring system(IPSS),patients at high risk group shall transplant as soon as possible after the disease diagnosed,and low-risk group shall be transplanted after treated with other drugs while the effect is not well.Patients without a matched family donor or unrelated donor are referred to HLA-haploidentical unrelated cord blood transplantation(UCBT).Preparative regimens include myeloablative or reduced intensity conditioning(RIC),and the outcome of transplantation is comparable.