改良非清髓性异基因造血干细胞移植治疗SAA疗效观察

目的探讨非清髓性异基因造血干细胞移植(NAST)治疗重型再生障碍性贫血(SAA)的方法及疗效。方法对20例急性SAA患者进行NAST,预处理采用小剂量环磷酰胺、抗淋巴细胞球蛋白或抗胸腺细胞球蛋白;移植后采用环孢菌素、骁悉、抗CD25预防移植物抗宿主病(GVHD)。采用短串联重复序列复合扩增技术检测供者植入情况。结果10例异基因外周血造血干细胞移植患者造血功能获得快速重建;8例脐血造血干细胞移植患者均未植入,但自身造血亦获得安全重建。发生急性GVHD1例,慢性GVHD2例,严重感染性休克、间质性肺炎、败血症各1例均治愈,突发心衰死亡1例,造血重建失败并发感染死亡2例。结论改良NAST疗效肯定、植入率高、并发症少、造血功能恢复快,是治疗SAA的有效方法。

Effect of improved nonmyeloablative allogeneic peripheral blood stem cell transplantation for severe aplastic anemia

To research the method and effect of nonmyeloablative allogeneic peripheral blood stem cell transplantation (NAST) in the treatment of severe aplastic anemia(SAA). Twenty patients with SAA received improved NAST.They were conditioned with small dosage of immunosuppressive agents of cyclophosphamide (CTX) and anti- lymphoid cell globulin or anti- thymus gland cell globulins; cyclophosphamidemycophenolate mofeti and anti-CD25 were used to prevent the graft-versus-host disease (GVHD). The engrafted donor cell were identified by STR-PCR. Ten patients who received allogene peripheral blood stem cell transplantation acquired fast reconstruction and eight patients who received cord blood stem cell transplantation were not implanted but recovered hematopoiesis. One developed acute GVHD, Two of them developed chronic GVHD, Three patients who developed respectively severe septic shock, interstitial pneumonia and ichorrhemia were all cured. One patient died of acute heart failure,and two patients died of hematopoiesis reconstruction failture and infection. Improved NAST is a effective project for SAA because of its positive curative effect, high rate of embedding, few complication and rapid recovering hematopiesis.