非亲缘异基因造血干细胞移植治疗白血病患者疗效观察

Clinical observation of unrelated allogeneic hematopoietic stem cell transplantation in leukemia patients

目的探讨非亲缘异基因造血干细胞移植(URD-HSCT)治疗白血病的效果。方法 10例白血病患者(急性髓细胞白血病第1次缓解期3例,急性淋巴细胞白血病第1次缓解期3例、第2次缓解期1例,慢性髓细胞白血病慢性期3例)接受URD-HSCT治疗。所有患者均采用经典的或改良的白消安联合环磷酰胺预处理方案。4例采用环孢素+短程甲氨蝶呤+吗替麦考酚酯预防移植物抗宿主病(GVHD),另6例患者加用抗胸腺细胞免疫球蛋白。输注供者有核细胞中位数为5.6×108/kg,CD34+细胞中位数为3.3×106/kg。结果除1例在移植后早期死亡不能评估外,其余9例均证实植活。发生急性GVHDⅠ度3例和Ⅱ度、Ⅲ度、Ⅳ度各1例,局限性慢性GVHD7例;发生真菌感染4例、CMV血症3例、出血性膀胱炎3例。10例患者目前无病存活7例,生存期为3个月～10年。结论 URD-HSCT安全而耐受性好,移植相关并发症仍是影响URD-HSCT效果的主要问题。

Objective To study the therapeutic effectiveness and associated complications of unrelated allogeneic hematopoietic stem cell transplantation(URD-HSCT).Methods Ten patients with leukemia(3 acute myeloid leukemia in first complete remission,3 acute lymphoblastic leukemia in first complete remission,1 acute lymphoblastic leukemia in second complete remission,and 3 chronic myeloid leukemia in chronic phase) received URD-HSCT.All patients were subjected to busufan/cyclophosphamide(Bu/Cy) or modified Bu/Cy2 regimen.The graft-versus-host disease(GVHD) was prevented by cyclosporin A,short-term methotrexate and mycophenolate mofetil regimen in 4 patients,and other 6 patients additionally received antithymocyte globulin on day 1 to 3 before transplantation.A median of 5.6×108/kg nucleated cells and 3.3×106/ kg CD34 + cells were transfused.Results Except for 1 patient died early after transplantation,other 9 patients achieved engraftment confirmed by blood type,chromosome test and DNA polymerphism.Three patients developed gradeⅠ,1 patient developed grade Ⅱ,1 patient developed grade Ⅲ,and 1 patient developed grade Ⅳ acute GVHD.Seven patients experienced local chronic GVHD.Four patients suffered from fungal infection,3 patients had cytomegalovirus infection,and 3 patients developed hemorrhagic cystitis.Conclusions URD-HSCT is safe and good tolerance can be achieved.Controlling transplant-related complications is critical for the outcomes of URD-HSCT.