抗人T淋巴细胞兔免疫球蛋白预防异基因造血干细胞移植中急性移植物抗宿主病的临床研究

Clinical research on prophylaxis of aGVHD in allogeneic stem cell transplantation with anti - human T - lymphocyte rabbit immunoglobulin

目的探讨异基因造血干细胞移植中抗人T淋巴细胞兔免疫球蛋白（ATG）联合环孢霉素A（CsA）、霉酚酸酯（MMF）、甲氨蝶呤（MTX）对促进移植植入和预防急性移植物抗宿主病（aGVHD）的作用。方法15例恶性血液病及5例重型再生障碍性贫血（SAA）患者实施血缘相关供者异基因造血干细胞移植，其中8例为人类白细胞抗原（HLA）配型全相合，12例HLA配型为单倍体相合。在移植前5d至前2d应用ATG 10．0mg／kg。供者应用重组人粒细胞集落刺激因子（rhG—CSF）5μg／（kg·d），连续应用5d后采集外周血干细胞，单个核细胞（MNC）计数中位数为5．3×10^8／kg，CD34^＋细胞计数中位数为6．0×10^6／kg。结果移植后所有受者均获得造血重建，中性粒细胞（ANC）≥0．5×10^9／L和血小板（Plt）≥20×10^9／L中位时间分别为12d和14d。出现aGVHD7例，其中Ⅰ度皮肤aGVHD 3例；Ⅱ度肠道aGVHD 2例；Ⅲ度及Ⅳ度肠道aGVHD各1例。结论ATG在促进造血干细胞的植入，预防aGVHD的发生和降低其严重程度方面具有明显的效果。

Objective To investigate the effect of ATG in combination with CsA, MMF and MTX in the process of implantation and on preventing acute graft versus host disease （aGVHD） in allogeneic hematopoietic stem cell transplantation （ allo - HSCT）. Methods Fifteen patients of hematologic malignancies and 5 patients of severe aplastie anemia （SAA） were administrated related allo - HSCT. The HLA typing was identical between the receptors and the donors in 8 cases, and was haploidentieal in 12 cases. ATG was adminstrated by the patients with the dose of 10 mg/kg, 2 to 5 days before transplantation. All the donors received a five - day course of rhG - CSF （5 mg per kilogram of bodyweight per day） , following by collection of peripheral blood stem cells. The number of MNC and CD34^＋ were 5.3 × 10^8/kg,6.0 × 10^6/kg. Results All patients achieved hemotopoietic restruction successfully. The number of ANC was up to 0.5 x 109/L with a median time of 12 days （ range 9 - 14） and the number of Pit was up to 20 × 10^9/L with a median time of 14 days （ range 9 - 35 ） after transplantation. There were 3 patients who got aGVHD in skin （grade Ⅰ ）, and 4 in gut （grade Ⅱ 2/4, grade Ⅲ 1/4, gradeⅣ 1/4）. Conclusions ATG has obvious effect on promoting the implantation of hematopoietic stem cell, preventing the occurrence of aGVHD, and reducing its severity.