异基因外周血干细胞移植治疗白血病并发症分析及防治

Analysis of the prevention of the complications of 40 leukemia patients treated by allogeneic peripheral blood hematopoietic stem cell transplantation

目的探讨不含全身照射(TBI)预处理方案异基因外周血干细胞移植(allo-PBSCT)治疗40例白血病并发症的发生情况及其防治。方法分析我院2001年1月～2008年10月allo-PBSCT治疗的40例患者临床资料。40例的供者均为HLA-Ⅰ/Ⅱ抗原完全相合的同胞,采用不含TBI改良Bu/Cy及减低剂量Bu+Arac+CTX+氟达拉滨(Flu)预处理方案。氨磷汀预防口腔黏膜炎,前列腺素E1预防肝静脉闭塞病(HVOD);40例均在预处理及移植后造血恢复期应用更昔洛韦预防巨细胞病毒(CMV)感染,采用环胞菌素A和短程MTX进行GVHD的预防。结果40例患者中出现Ⅰ度口腔黏膜炎23例(57.6%),Ⅱ度口腔黏膜炎4例(10%)。Ⅳ度口腔黏膜炎2例(0.5%);40例患者中均未发生急性GVHD及急性CMV感染;19例(47.5%)出现慢性GVHD,出血性膀胱炎(HC)发生率0.5%,间质性肺炎(IP)发生率0.25%;40例均未出现肝静脉闭塞病(HVOD);40例移植患者中5例(12.5%)死于慢性GVHD移植相关并发症。结论预处理及移植后造血恢复期应用更昔洛韦预防CMV感染治疗,可能会减少移植患者CMV感染;使用细胞保护剂氨磷汀可能会减少或减轻移植患者口腔黏膜炎发生;慢性GVHD已日益成为影响异基因外周血干细胞移植后期生命及生活质量的重要因素。

Objective To analyze the prevention of the complications of 40 leukemia patients treated by allogeneic peripheral blood stem cell transplantation （alIo-PBSCT） of non-intradiation pretreatment.Methods To analyze clinical datas of 40 leukemia patients underwent allo-PBSCT from HLA-identical siblings in our hospital from January 2001 to October 2008.The conditioning regimen consisted of the high dose combination chemotherapy：Busulfan （Bu） ＋ Cytarabine （Ara-c） ＋ cyclophosphamide （CTX） ＋ Me-CCNU and a decreased dose combination chemotherapy：Bu＋Ara-c ＋ CTX＋ Fludarabine（Flu）.Amifostine,Prostaglandin EI,Ganciclovir ,Cyclosporine-A （CsA） plus Methotrexate （MTX） ware respectively given to prevent oral mucosal ulcers,HVOD,CMV infection, GVHD.Results In 40 patients,23 cases had Ⅰ degree of oral mucositis（57.6%）,4 cases with Ⅱ degree of oral mucositis（10%）, 4 cases with Ⅳ degree of oral mucositis（0.5%）.The incidence of Hemorrhagic cystitis and Interstitial pneumonia were separately 0.5%,0.25%.All of survivals did＇t have acute GVHD,CMV infection and HVOD. 19 cases（47.5%） had chronic GVHD,whose complications were the main causes of death to 5 cases of them.Conclusion Using Ganciclovir for during pretreatment period and hematopoietic recovery period may reduce the probability of CMV infection;Using Amifostine may reduce the probability of oral mucosal ulcers;Chronic GVHD has been an important factor to affect the quality of life of patients treated by allo-PBSCT in later period.