150例异基因造血干细胞移植治疗恶性血液病的疗效分析

目的：分析异基因造血干细胞移植（allo-HSCT ）治疗恶性血液病的疗效及安全性，探讨移植相关并发症及影响预后的因素。方法回顾性分析2010年6月至2015年6月贵州医科大学附属医院造血干细胞移植中心行 allo-HSCT 的150例恶性血液病患者的病历资料。按照供者类型不同，将其分为同胞全相合移植组（n＝52）和单倍体移植组（n＝98）。所有患者均采用改良白消安／环磷酰胺（BU ／CY）为预处理方案，单倍体移植组加用兔抗人胸腺细胞免疫球蛋白（ATG），移植物抗宿主病（GVHD）的预防采用短疗程甲氨蝶呤＋环孢素 A ＋吗替麦考酚酯，对150例患者疗效、安全性及移植相关并发症进行分析。结果150例患者经血型、染色体或 DNA 多态性检测证实均达到完全供者细胞植入，同胞全相合移植组平均中性粒细胞及血小板重建时间为移植后12 d 和16 d ，单倍体移植组平均中性粒细胞及血小板重建时间为移植后13 d 和16 d 。150例患者中，59例（39．3％）患者出现口腔黏膜溃疡，47例（31．3％）患者移植后100 d 内发生细菌和（或）真菌感染，41例（27．3％）患者移植后100 d 内发生巨细胞病毒感染，48例（32．0％）患者发生急性 GVHD ，43例（28．7％）患者发生慢性 GVHD 。随访1～60个月，中位随访时间23个月。115例（76．7％）患者无病存活，其中同胞全相合移植组38例（73．1％，38／52），单倍体移植组77例（78．6％，77／98）。35例（23．3％，35／150）患者死亡，其中同胞全相合移植组死亡14例（26．9％，14／52），单倍体移植组死亡21例（21．4％，21／98）。死因分析发现，12例（8．0％）因移植相关并发症死亡，其中5例（3．3％）因严重感染，7例（4．7％）因急性 GVHD ；23例（15．3％）患者因原发病复发死亡。两组患者生存率及死亡率比较差异无统计学意义（P＞0．05）。结论 allo-HSCT 治疗恶性血液病安全有效，单倍体移植的疗效与安全性接近全相合移植，急性 GVHD 和感染是严重影响移植疗效和预后的危险因素，需早期预防。

Curative effect analysis of allogeneic hematopoietic stem cell transplantation for 150 patients with hematological malignancies

Objective To evaluate the efficacy and safety and to analyze related complications and potential prognostic factors of allogeneic hematopoietic stem cell transplantation(allo-HSCT ) on hematological malignancies .Methods Patients with hemato-logical malignancies who underwent allo-HSCT from June 2010 to June 2015 were investigated in this retrospective study .Accord-ing to the donor types ,it was divided into compatriots sibling-matched transplantation group (n = 52) and haploid transplantation group (n= 98) .The preconditioning regimens were busulfan/cyclophosphamide ,and anti-thymocyte globulin were needed in haploid transplantation group .Short-term methotrexate + cyclosporine A + mycophenolate mofetil were used for prevention of graft-ver-sus-host disease .The efficacy and safety and related complications of allo-HSCT were analyzed .Results All patients achieved full donor type engraftment ,which was identified by blood type ,chromosome test and DNA polymorphism .The mean times of neutro-phil and platelet engraftment were 12 d and 16 d in compatriots sibling-matched transplantation group and 13 d and 16 d in haploid transplantation group ,respectively .59 cases (39 .3% ) patients were oral mucosa ulcer ,47 patients (31 .3% ) were bacteria and/or fungal infection ,41 cases (27 .3% ) patients were CMV infection ,48 cases (32 .0% ) were acute GVHD ,43 patients (28 .7% ) were chronic GVHD .The median follow-up time of 23 months (1 - 60 months) ,115 patients (76 .7% ,115/150) were disease-free sur-vival ,including 38 cases (73 .1% ,38/52) in compatriots sibling-matched transplantation group ,77 cases (78 .6% ,77/98) in haploid transplantation group ;35 cases (23 .3% ,35/150) patients were died ,including 14 cases (26 .9% ,14/52) in compatriots sibling-matched transplantation group ,21 cases (21 .4% ,21/98) in haploid transplantation group .Death cause analysis showed that 12 ca-ses (8 .0% ) complications from transplantation related death ,of which 5 cases (3 .3% ) were severe infection ,7 cases (4 .7% ) caused by acute GVHD ,23 cases (8 .7% ) patients died because of the primary disease recurrence .The survival rate and mortality was similar between the two groups (P> 0 .05) .Conclusion Allo-HSCT is safe and effective treatment in hematological malignan-cies .The curative effect and security with haploid transplantation were similar to compatriots sibling-matched transplantation .It is necessary to prevent prognostic impact factors such as acute GVHD and infection early .