单倍型造血干细胞移植的新进展及其临床结果

New development and clinical outcomes of haploidentical hematopoietic stem cell transplantation

目前,国内外尚无单倍型相合未去T细胞移植成熟的方案,对于难治和高危白血病患者,化疗预后是很差的,应不失时机进行异基因造血干细胞移植,如果能够跨越人类主要组织相容性抗原的限制,用人类主要组织相容性抗原半相合的亲属作为造血干细胞移植的供体,就可以彻底解决干细胞来源问题。采用诱导免疫耐受新方法可提高预防移植物抗宿主病疗效。国外通过使用抗胸腺细胞球蛋白、氟达拉滨、甲强龙和全身照射使人类主要组织相容性抗原单倍型骨髓移植排斥率由40%降到0-5%,国内基本采用体外不去T和诱导免疫耐受的移植方式,结果优于国外报告,显著的疗效与国内未进行T细胞清除相关。

There is no mature scheme on haploidentical non-T-depleted transplantation in China. Prognosis of chemotherapy is poor for refractory and high-risk leukemia. Allogene hematopoietic stem cell transplantation （allo-HSCT） should be applied without delay. If we can go beyond the histocompatibility leukocyte antigen （HLA） boundary, HLA-haploidentical family members would became the resource of allo-HSCT donors. Graft versus host disease （GVHD） prophylaxis could be improved by inducing immune tolerance. Antithymocyte globulin, fludarabine, urbason and general irradiation were used to decrease histocompatibility antigen from 40% to 0-5% abroad. Non-T-depleted method and inducing immune tolerance were mostly employed in China, which could obtain a better outcome. The significant outcome is closely associated with non-T-depleted method.