血缘关系供者外周血干细胞移植中移植物细胞组分对造血重建和移植物抗宿主病的影响

Effects of graft compositions on hematopoietic reconstitution and graft-versus-host disease in related donor peripheral blood stem cell transplantation

目的探讨HLA全相合血缘关系供者外周血干细胞移植（PBSCT）中移植物细胞组分对恶性血液病患者移植后造血重建、移植物抗宿主病（GVHD）的影响。方法回顾性分析我科107例接受HLA全相合血缘关系供者PBSCT的恶性血液病患者，其移植物细胞组分与移植后患者造血重建、GVHD的关系。结果移植物各细胞组分与粒细胞重建时间无关；单个核细胞（MNC）、CD34^＋细胞数与血小板重建时间呈负相关（r值分别为-0．32和-0．21，P值均〈0．05）。CD34^＋、CD34^＋CD38^-细胞数与急性GVHD发生呈负相关（r分别为-0．24和-0.29，P值均〈0．05）。淋巴细胞各亚群数量与急性GVHD发生均无明显关系。CD25^＋CD4^＋、CD3^＋、CD4^＋CD3^＋细胞数及CD4^＋／CD8^＋细胞比值与慢性GVHD发生均呈正相关（P值均〈0．05），且相关系数均大于0．4，其中CD25^＋CD4^＋细胞数与慢性GVHD相关系数高达0．78。CD34^＋、CD34^＋CD38^-细胞数与慢性GVHD发生无明显关系。结论PBSCT中输入MNC、CD34^＋、CD34^＋CD38^-细胞数增加到一定阈值后，增加细胞数并不能进一步有效促进患者造血重建，反而有可能因输入淋巴细胞数增加而增加患者慢性GVHD、广泛慢性GVHD的发生率。

Objective To explore the effects of graft composition on hematopoietic reconstitution and graft-versus-host disease（GVHD） in HLA-identical related donor peripheral blood stem cell transplantation （PBSCT） for hematological malignancies. Methods The relationship between the number of graft composition and their hematopoietic reconstitution and GVHD in 107 patients with hematological malignancies undergoing HLA-identical related donor PBSCT was retrospectively analyzed. Results None of the graft composition numbers had correlation with the time of neutrophil reconstitution. There was a negative correlation between the number of mononuclear cells （MNCs） or CD34^＋ cells and the time of platelet reconstitution （P 〈 0.05 ） with the absolute correlation coefficients below 0.4, and so did between the number of CD34^＋ or CD34^＋ CD38^- cells and the development of acute GVHD （ P 〈 0.05 ） and their absolute correlation coefficients. Each lymphocyte subset number had no correlation with acute GVHD. There was a positive correlation between the number of CD25^＋ CD4^＋ , CD3^＋ or CD4^＋ CD3^＋ cells or CD4^＋/CD8^＋ ratio and the development of chronic GVHD （ P 〈 0.05 ）. And the correlation coefficients all exceeded 0.4, more over, CD25^＋ CD4^＋ cells number reached up to 0.78. CD34^＋ , CD34^＋ CD38^- cells number had no correlation with chronic GVHD. Conclusion In HLA-identical related donor PBSCT, further increasing infused MNC, CD34^＋, CD34^＋ CD38^- cells can no more accelerated hematopoietic reconstitution after these cells attained their threshold values, otherwise the incidence of cGVHD might increase clue to the increase of the accompanied lymphoeytes.