单倍体HLA不相合非清髓性异基因造血干细胞移植治疗血液病临床研究

目的:探讨组织相融抗原(HLA)不相合,主要血型不合的非清髓性异基因外周造血干细胞移植(NASCT)治疗血液病的可行性。方法:对7例血液病患者接受2～3个位点不合,ABO主要血型不合的未去T细胞NASCT,连续接受免疫抑制治疗。其中男3例,女4例,中位年龄41(21～58)岁。7例中,急性白血病第1次完全缓解(CR1)3例,CR2 1例,骨髓增生异常综合征(MDS)1例,极重症再生障碍性贫血(SSAA)1例,再障-阵发性睡眠性血红蛋白尿(AA-PNH)1例。结果:7例患者均取得三系重建造血,移植后粒细胞>0．5×109／L及血小板>20×109／L的中位时间分别为移植后第14天和第21天,植入直接证据检测证实完全供者造血,2例发生急性移植物抗宿主病,2例发生慢性移植物抗宿主病。结论:经粒细胞集落刺激因子动员的外周造血干细胞采用NASCT及持续性免疫抑制剂应用特别是ATG应用于未去T细胞的NASCT成功率高,疗效好,为扩大供者来源治愈血液病提供了新手段。

Clinical study of HLA non-identical and nonmyeloablative allogeneic peripheral blood hematopoietic stem cells transplantation for hematological diseases

Objective: To explore the significance of non-identical and nonmyeloablative allogeneic peripheral blood hematopoietic stem cell transplantation in the treatment of hematological diseases. Method: Seven patients with hematological diseases were treated with two-three loci non-identical NAST, without ex-vitro T cell depletion. Of seven patients, 3 were acute leukemia (AL) in first complete remission (CR1), 1 AL in CR2, 1 Myeloid Dysplastic Syndrome (MDS), 1 Severe Severe Aplastic Anemia (SSAA), 1 AA-paroxysmal nocturnal hemoglo-binuria (PNH), 1 non-Hodgkin Lymphoma (NHL). Result: All 7 patients passed the hemapoietic suppression stage and achieved engraftment. 2 developed acute GVHD and the other 2 had chronic GVHD. Conclusion: Non-identical and nonmyeloablative allogeneic peripheral blood hematopoietic stem cell transplantation is safe, less toxic and curative approach for patients with hematological diseases.