异基因造血干细胞移植治疗顽固性银屑病并发慢性粒细胞白血病1例

Allogenic hematopoetic stem cells transplantation in the treatment of refractory psoriasis patients complicated with chronic myelogenous leukemia

目的:探讨异基因造血干细胞移植治疗1例经常规治疗效果不佳,且并发慢性粒细胞白血病的顽固性银屑病患者的疗效和安全性。方法:患者男,36岁。经皮损组织病理检查确诊为银屑病,经常规治疗效果不佳,并出现白细胞增高,经骨髓穿刺检查确诊为慢性粒细胞白血病。采用改良的BuCY方案(羟基脲、阿糖胞苷、白消安、环磷酰胺)进行预处理,移植物抗宿主病的预防采用抗胸腺细胞球蛋白(ATG)+环孢素(CsA)+甲氨蝶呤(MTX)方案。观察患者移植后临床表现、造血等指标的变化。结果:患者移植后银屑病皮损完全消退,完全供者植入,Ph染色体阴性,慢性粒细胞白血病获治愈。结论:随访12个月后,该例患者经异基因造血干细胞移植治疗的近期疗效显著,虽然远期疗效尚在进一步观察中,但随访结果提示该例患者有望获得根治。

Objective： To explore the clinical effect of allogenic hematopoetic stem cells transplantation in the treatment of refractory psoriasis complicated with chronic myelogenous leukemia. Methods： A 36-year-old male patient was diagnosed as psoriasis by clinical characteristics and histological findings. The case had unsuccessful results with the routine therapy. Chronic myelogenous leukemia was established by bone marrow biopsy. Pretransplant conditioning was modified by BuCY protocol（hydroxyurea, Ara-C, busulfan, cyclophosphamide）. Antithymocyte globulin, cyclosporine and methotrexate were used to prevent graft versus host disease. Clinical manifestations, hematopoietic reconstitution were observed before and after transplantation. Results： After transplantation, the lesions of psoriasis were regressed and the symptoms of chronic myelogenous leukemia were resolved. Conclusion： Allogenic hematopoetic stem cells is obviously effective for refractory psoriasis, the duration of remission remains to be observed in long-term follow up.