摘要
为了探讨单倍体相合外周血造血干细胞移植(hi-PBSCT)治疗恶性血液病的疗效和相关并发症,对15例高危患者进行体外不去除T细胞的hi-PBSCT。预处理采用改良的Bu/Cy或TBI/Cy方案,用抗胸腺细胞球蛋白(ATG)、环孢素A(CsA)、霉酚酸酯(MMF)和短程甲氨蝶呤(MTX)预防移植物抗宿主病(GVHD),4例加用抗CD25单克隆抗体。回输G-CSF动员的外周血干细胞,输注MNC中位数为8.16(3.92-10.86)×108/kg,CD34+细胞中位数为4.51(1.27-5.95)×106/kg。结果显示:所有患者均植入成功,ANC≥0.5×109/L的中位时间为14(11-19)天,Plt≥20×109/L的中位时间为22(11-52)天。Ⅰ-Ⅱ度急性GVHD6例,慢性GVHD2例。移植后100天内均出现感染,病原学确诊为细菌感染8例,CMV感染6例。5例患者出现复发。中位随访213(42-589)天,死亡8例,存活7例。结论:hi-PBSCT治疗无HLA相合供者的恶性血液病患者是可行而且有效的,进一步降低移植相关并发症是主要问题。
This study was aimed to explore the efficacy and associated complications of haploidentical peripheral blood stem cell transplantation (hi-PBSCT) without ex vivo T-cell depletion in treatment of hematological malignancies. 15 high-risk patients received HLA 1 - 3 loci ( A, B, or DRB1 ) mismatched hi-PBSCT. The modified Bu/Cy or TBI/ Cy regimen was used for preconditioning of patients. The anti-thymocyte globulin, cyclosporin A, methotrexate and mycophenolate mofetil were used for GVHD prophylaxis. 4 cases were administrated with anti-CD25 monclonal antibody. G-CSF-mobilized peripheral blood stem cells were infused, with the median number of infused nucleated cells was 8.16 (3.92 - 10.86) × 10^8/kg and that of CD34^ + ceils was 4.51 ( 1.27 -5.95 ) × 10^6/kg. The results showed that the rapid engraftment was observed in all cases. The median times of neutrophil recovery ≥0.5 x 109/L and platelet recovery 〉120 x 109/L were 14 ( 11 - 19 ) and 22 ( 11 - 52 ) days after transplantation respectively. 6 cases developed acute GVHD of grade I - II , and 2 cases experienced chronic extensive GVHD. Infection within 100 days after hi-PBSCT was documented in all cases. 8 cases were subjected to bacterial infection, and six got cytomegalovirus infection. Relapse occurred in five cases. Overall survival of patients was 46.7% (7/15), with a median follow-up of 213 (42 - 589 ) days. In conclusion, hi-PBSCT provides an effective alternative treatment for high-risk patients in lack of matched donors, and to reduce the high transplantation-related mortality.
出处
《中国实验血液学杂志》
CAS
CSCD
2009年第5期1326-1329,共4页
Journal of Experimental Hematology
基金
首都医学发展科研基金重点支持项目(编号2007-2040)