母供子非去T细胞性单倍体异基因造血干细胞移植治疗恶性血液病

The clinical study of the Non-T-depleted HLA halploidentical stem cell transplantation with maternal donors in hematological malignancies

目的：对18例恶性血液病进行母供子非去T细胞性单倍体异基因造血干细胞移植（Allo-HSCT）治疗，探讨其疗效及毒性反应。方法：6例急性髓系白血病（AML-M2 3例，AML-M4 1例，AML-M5b 2例），3例慢性粒细胞白血病（伴骨髓纤维化1例），8例急性淋巴细胞白血病（ALL），非霍奇金淋巴瘤（Ⅳ期B组）1例，以母亲为供者进行非去T细胞性单倍体Allo-HSCT。供者动员方案：G-CSF 300μg／12h×5d后采集造血干细胞。输注D34^＋细胞（3．58～8．90）×10^5／kg。预处理方案为：MeCCNC 250mg·m^-2·d^-1×1d，Ara-C4g·m^-2·d^-1×2d，Bu4mg·kg^-1·d^-1×3d，CTX1．8g·m^-2·d^-1×2d。ALL患者以全身放疗（TBI）代替Bu。以CsA、MMF、MTX和ALG预防移植物抗宿主病（GVHD）。结果：所有患者均顺利完成预处理。移植后发生急性GVHD16例、慢性GVHD10例，出血性膀胱炎1例。全部患者在移植后10～20d获造血重建。18例患者中12例存活。结论：非去T细胞性单倍体Allo—HSCT是治疗恶性血液病的一种安全、有效的方法；同时提示在以后的单倍体异基因造血干细胞移植中优先选择母亲供体，对降低GVHD的严重程度、提高移植成功率是有帮助的。

Objective：To explore the efficiency and toxicity of non-T-cell-depleted HLA halpoidentical hematopoietic stem cell transplantation with maternal donors for hematological malignancies. Method： 18 patients consisted of 6 with acute myeloid leukemia （AML）, 3 with chronic myeloid leukemia （CML, one case with myelofibrosis）, 8 with acute lymphocytic leukemia （ALL）, one case with non-Hodgkins lymphoma（NHL） ,received non-T-cell-depleted HLA halpoidentical stem cell transplantation from maternal donors. Hematopoietic stem cell （HSC） were mobilized by G-CSF 300μg/12 hours×5 d. （3.58～8.90）×10^6 CD34^＋ cells/kg were transplanted. Conditioning regimen included MeCCNC 250 mg·m ^-2·d^-1×1d, Ara-c 4 gm^-2·d^-1×2 d, Bu 4 mg·kg^-1·d^-1×3d, CTX 1.8 g·m^-2·d^-1×2d. The patients with ALL received TBI instead of Bu. CsA, MMF, MTX and ATG were used to prevent graft versus host disease （GVHD）. Result： All of the patients were tolerant with the conditioning regimen well. Acute and chronic GVHD developed in 16 and 10 patients respectively. Hematopoiesis reconstitution resumed on day 10 to day 20 after transplantation. 12 patients survived. Conclusion：Non-T-cell-depleted HLA halpoidentical stem cell transplantation was an effective therapy for patients with hematological malignan cies, also Non-T-cell-depleted HLA halpoidentical stem cell transplantation received stem cell from maternal donor maybe help to decrease the grade of acute graft versus host disease and increase successful rate of transplantation.