ABO血型不合对同胞异基因外周血干细胞移植的影响

Effect of ABO-incompatible on sibling allogeneic peripheral blood stem cell transplantation(allo-PBSCT)in treatment of hematologic malignancies

目的探讨HLA配型相合但ABO血型不合的同胞异基因外周血干细胞移植（allo-PBSCT）治疗血液恶性肿瘤的疗效。方法对2001年6月至2005年9月的68例HLA配型相合的血液恶性肿瘤患者进行同胞allo-PBSCT，其中ABO血型不合30例（血型不合组），ABO血型相合38例（血型相合组）。急性髓细胞白血病（AML）、骨髓增生异常综合征（MDS）和慢性粒细胞白血病（CML）患者采用马利兰（BU）／环磷酰胺（CY）预处理方案；急性淋巴细胞白血病（ALL）和非霍奇金氏淋巴瘤（NHL）患者采用全身照射（TBI）／CY方案；多发性骨髓瘤（MM）患者采用TBI／CY／马法兰方案。移植物抗宿主病（GVHD）的预防采用霉酚酸酯（MMF）、环孢素A（CSA）和短程甲氨喋呤（MTX）三联方案。结果（1）除1例植入失败外．其余67例患者全部造血重建。中性粒细胞绝对值≥0．5×10^9／L和血小板数≥20×10^9／L的平均时间为移植后＋12（＋9～＋15）d和＋21（＋15～＋40）d，血型不合组与血型相合组植入的时间差异无统计学意义（P〉0．05）。（2）血型不合组均未出现急性溶血反应，但与血型相合组比较，红系造血延迟，在供／受者血型为A／O的7例患者中有3例（42．9％）发生纯红细胞再生障碍性贫血（PRCA）。血型不合组于移植后60d（24～153d）血型成功转变为供者型。（3）随访至2005年9月30日，血型不合组急性GVHD发生率（20．0％）比血型相合组（2．6％）高（P=0．019），但慢性GVHD发生率、肝静脉栓塞综合征（VOD）发生率、巨细胞病毒（CMV）感染发生率、出血性膀胱炎（HC）发生率、疾病复发率及死亡率与血型相合组比较，差异无统计学意义（P〉0．05）。（4）用Kaplan-Meier生存分析发现，血型相合组和血型不合组患者之间预期4年的生存率差异无统计学意义（P〉0．05）。结论ABO血型不合可以进行allo-PBSCT，并且不影响干细胞移植的植活，虽然急性GVHD的发生率较血型相合组高，但其对复发率、死亡率及生存率无显著影响。

Objective To investigate the efficacy of HLA-matched ABO-incompatible sibling allogeneic peripheral blood stem cell transplantation （allo-PBSCT） in treatment of hematologic malignancies. Methods Between June 2001 and September 2005, 68 patients with hematologic malignancies received allo-PBSCT from HI.A-identical sibling donors. Among them, 38 were ABO-compatible （ABO-compatible group）, 30 ABO-incompatible （ABO-incompatible group）. Conditioning regimen of all patients： BU/CY used as conditioning regimen in AML, MDS and CMI. patients; TBI/CY used in ALL and NHL patients. TBI/CY/Melphan used in MM patients. GVHD prophylaxis： A combination of cyclosporine （CSA） and mycophenolate mofetil （MMF） and methotrexate （MTX） was administered for GVHD prophylaxis. Results （1） Sixty seven patients were all engrafted, and only one patient was graft failure. The median time （range） to neutrophils ≥0. 5 × 10^9/L and platelets≥20 ×10^9/L was ＋ 12 （ ＋ 9- ＋ 15） and ＋ 21 （ ＋ 15- ＋ 40） days post transplant respectively. The time to neutrophil and platelet engraftment had no significant difference between ABO-ineompatible group and ABO-eompatible group （P〉0. 05） ; （2） Thirty patients with ABO-incompatible allo-PBSCT had no evidence of hemolysis. In ABO-incompatible group, the onset of erythropoiesis after allo PBSCT was delayed. Three of 7 patients with blood group ＂O＂ receiving a group ＂A＂ developed pure red cell aplasia （PRCA）. The blood type of 30 patients would transfer to the type of donors in 60 days （24- 153days） after transplantation. （3） Following up to 30th, Sep. 2005, the incidence of aGVHD was higher in ABO-incompatible group （20. 0%） than that in ABO-compatible group （2. 6%, P = （1. 019）. The incidence of cGVHD, VOD, HC, CMV infection, disease relapsed rates and mortality had no significant difference between ABO-incompatible and ABO-compatible recipients （P〉0.05）. （4） Kaplan- Meier survival analysis revealed the rates of survival had no significant difference between ABO-incompatible and ABO-compatible recipients （P〈0. 05）. Conclusions ABO-incompatible allo-PBSCT is fairly safe if there is indication. Although the incidence of aGVHD was higher in ABO-incompatible group than that in ABO-compatible group, but there was no effect on engraftment, incidence of cGVHD or prognosis.