亲缘半相合造血干细胞移植中第三方脐血辅助输注的作用分析

目的 探讨第三方脐血辅助输注在亲缘半相合造血干细胞移植中的作用.方法 回顾性分析2010年1月至2013年5月收治的确诊为恶性血液病,并已完成亲缘半相合造血干细胞移植的66例患者的临床资料,以是否回输第三方脐血细胞将患者分为两组：25例辅助性回输脐血者为试验组,41例未回输脐血者为对照组.对患者移植后造血恢复情况、移植物抗宿主病（GVHD）发生情况、其他并发症及预后等情况进行比较.结果 两组患者的年龄、性别、供者来源、疾病种类以及移植前疾病状况比较差异均无统计学意义（均P＞ 0.05）.两组采用预处理方案比较有差异（P=0.00）,但此差异无临床意义.试验组回输单个核细胞数（MNC）为（9.94±2.88）×10^8/kg、CD34＋（5.46±3.54）×10^6/kg,对照组回输MNC （7.80±0.82）×10^8/kg、CD34＋ （3.54±1.60）×10^6/kg,试验组回输的MNC数多于对照组（P=0.00）,而两组回输的CD34＋细胞比较差异无统计学意义（P=0.16）.试验组较对照组WBC计数恢复快（P=0.023）,试验组与对照组WBC植活时间分别为（13.7±2.9）、（16.6±2.9）d;试验组Ⅲ～Ⅳ度GVHD发生率低（P =0.036）、早期细菌感染率（P=0.001）、真菌感染率（P =0.009）及出血性膀胱炎发生率低（P=0.00）均低于对照组,而两组PLT恢复情况（P=0.43）、Ⅰ～Ⅱ度GVHD发生率（P=0.27）以及植入综合征发生率（P=0.24）、肝窦阻塞综合征发生率（P=0.57）、病毒血症（P=0.31）发生率均差异无统计学意义.结论 使用脐血作为第三方辅助输注后可促进供者细胞植入,减轻GVHD的发生,但长期预后有待观察.

Haploidentical hematopoietic stem cell transplantation with supplemental umbilical cord blood infusion in treatment of malignant hematological diseases

Objective To evaluate the efficacy of haploidentical hematopoietic stem cell transplantation （HSCT） with supplemental umbilical cord blood （UCB） infusion in treatment of malignant hematological diseases.Method Clinical data of 66 patients with hematological malignancies treated with HSCT in our hospital between January 2010 and May 2013,were retrospectively analyzed.Among them 25 cases received infusion of human UCB before HSCT （experimental group） and other 41 cases had no UCB injection before HSCT （control group）.Results There were no differences in age,gender,donor type,disease categories,disease status before transplant between two groups （P 〉 0.05）.There was a significant difference in conditioning regimes between two groups （P 〈 0.05）,but no clinical implication.The infused mononuclear cell （MNC） count in experimental group was higher than that in control group （9.94 ± 2.88 × 108/kg vs.7.80 ±0.82 × 108/kg,P =0.00）,while there were no difference in infused CD34 ＋ cell count （5.46 ±3.54 × 106/kg vs.3.54 ± 1.60 × 106/kg,P =0.16）.Neutrophil recovery time in experimental group was shorter than that in control group （13.7 ±2.9 d vs.16.6 ±2.9 d,P =0.023）.The incidences of grade Ⅲ-Ⅳ acute graft versus host disease （aGVHD,P =0.036）,bacterial infection （P =0.001） and fungal infection （P =0.001）and hemorrhagic cystitis （P =0.00）in experimental group were lower than those in control group.There were no significant differences in platelet recovery time（P =0.43）,the incidence of grade Ⅰ-Ⅱ aGVHD （P =0.27）,implanted syndrome （P =0.24）,sinusoidal obstruction syndrome （P =0.57）and viraemia （P =0.31）between two groups.Conclusion HSCT with supplemental infusion of human UCB may alleviate the degree of aGVHD,but the long-term outcome remains to be studied.