非清髓异基因造血干细胞移植后的急性移植物抗宿主病

Acute Graft versus Host Disease in Non-Myeloablative Allogeneic Stem Cell Transplantation

本研究探讨非清髓异基因造血干细胞移植(non-myeloablative allogeneic stem cell transplantation,NAST)治疗血液病时急性移植物抗宿主病(aGVHD)的发生情况及临床特点。对71例患者中19例发生aGVHD者进行了分析,其中Ⅰ-Ⅱ度16例,Ⅲ-Ⅳ度3例。男9例,女10例,中位数年龄38岁(18-59岁)。结果发现,NAST的aGVHD发生率为26.7%(19/71),重度GVHD占4.2%(3/71);发生中位时间在移植后58天(17天-240天),其中3例发生于移植100天以后;临床表现以肠道及皮肤症状为主,尤以肠道为早发、多发明显,并有3例出现多部位急慢性GVHD混合表现。在早期达完全供者嵌合体(FDC)者中aGVHD发生率占38.2%(13/34),在早期为供受混合嵌合(MC)者中aGVHD发生率为16%(6/37),两组相比有明显差异。用NAST治疗血液病时所发生的急性、慢性GVHD比较迁延,治疗后期合并的严重感染是患者死亡的主要原因。结论:NAST治疗血液病时aGVHD发生率较低且较轻,有一定的迟发现象;早期形成FDC者aGVHD多见,易累及肠道和皮肤,病程较迁延。早期联合用药及加强综合治疗对提高aGVHD患者的存活率具有重要意义。

The objective of this study was to explore the occurrence and chnical features of acute graft versus host disease （aGVHD） in non-myeloablative stem cell transplantation （NAST）. 19 cases developed aGVI-ID out of 71 cases with NAST in recent years were analyzed retrospectively. Out of 19 cases, 9 males and 10 females at the median age of 38（18 -59）, 16 cases with grade Ⅰ - Ⅱ aGVHD, 3 cases with grade Ⅲ - Ⅳ aGVHD. The results indicated that the incidence of aGVHD in NAST was 26.7% （ 19/71 ）, and severe aGVHD was 4.2%, the median onset time was 58 days （ 17 -240 days） after transplantation. Skin and especially the intestine were the main target organs of aGVHD, while diarrhea occurred as the first symptom in 7 cases, 3 cases showed mixed acute and chronic GVHD involving more locations at the same time. aGVHD occurrence was 38.2% in those patients with full donor chimerism （FDC） and 16% in patients with the mixed chimerism （MC）. It is concluded that aGVHD in NAST is less in occurence, lighter in severity and later in time, but higher occurrence in those with early FDC, which intestine and skin are the main target organs. The chnical course is prolonged and easily comphcated with severe infection in the later phase. Early combined therapy with powerful supportive treatment is necessary.