目的 探讨同胞相合异基因造血干细胞移植治疗恶性血液病的临床疗效.方法 将26例恶性血液病患者按移植前疾病状态分为2组:高危组11例和标危组15例.2组患者均采用外周血同胞相合异基因造血干细胞移植.预处理方案:高危组采用全身照射+环磷酰胺,标危组采用白消安+环磷酰胺;移植物抗宿主病的预防:2组均采用环孢素A+短程甲氨蝶呤,或加霉酚酸脂.观察2组患者造血重建和急、慢性移植物抗宿主病、巨细胞病毒活动性感染/巨细胞病毒病、移植复发及移植相关死亡及无病生存等情况.结果 2组患者移植后均获得造血重建,均为完全供体嵌合型.2组患者移植后14例发生急性移植物抗宿主病(aGVHD),累积发病率为53.8%(14/26).9例发生慢性移植物抗宿主病(cGVHD),累积发病率为45.0%(9/20).2组患者移植后有20例(76.9%)出现巨细胞病毒血症,无一例患者发生巨细胞病毒病.标危组复发率与高危组比较差异无统计学意义(6.7%vs 18.2%,P＞0.05).标危组移植相关病死率与高危组比较差异有统计学意义(13.3%vs 54.5%,P＜0.05).高危组和标危组患者1、3年累积无病生存率分别为30.3%、85.1%和15.2%、68.1%(均P＜0.05).结论 移植前疾病状态是影响移植疗效的重要因素,移植物抗宿主病的发生对移植后疾病的复发及生活质量有重要的影响.%Objective To explore the clinical curative effect of matched sibling allogeneic hematopoietic stem cell transplantation(HSCT) on malignant hematopathy. Methods Twenty-six patients with malignant hematopathy were divided into two groups according to primary disease situation before transplantation: high-risk group (11 cases) and standard-risk group (15 cases). Matched sibling allogeneic HSCT were performed in all patients. Total body irradiation plus cyclophosphamide were used as conditioning therapy in high-risk group and busulphan plus cyclophosphamide were used in standart-risk group. A combined treatment with cyclosporine A and short course methotrexate (or adding mycophenolate mofetile) was given to patients in both groups to prevent graft-versus-host disease(GVHD). Hematopoietic reconstruction, acute and chronic GVHD, active cytomegalovirus (CMV) infection/CMV disease, post-transplantation relapse,transplant-related mortality (TRM), and disease free survival(DFS) were observed in both groups. Results All patients achieved complete hematopoietic reconstitution and full donor chimerism. After transplantation, the cumulative incidence of acute GVHD (aGVHD) was 53. 8％ (14/26) and the cumulative incidence of chronic GVHD(cGVHD) was 45.0％ (9/20). CMV viremia occurred in 20 patients(76.9％) ,but no CMV disease occurred in all patients. There were no significant differences in relapse rate between standard-risk group and high-risk group(6.7％ vs 18. 2％,P＞0. 05). The TRM rate in standard-risk group was significantly lower than that in high-risk group(13. 3％ vs 54. 5％ ,P＜0. 05). The rates of 1-year and 3-year DFS in high-risk group were different from those in standard-risk group (30.3％ vs 85.1％ and 15.2％ vs 68.1％, respectively;P＜0.05). Conclusion Primary disease situation before transplantation was an important factor influencing the curative effect of allogeneic HSCT. GVHD had an adverse effect on post-transplantation relapse and life quality.
展开▼
