单倍体外周血干细胞移植治疗恶性血液病6例

Haploidentical peripheral stem cell transplantation for treatment of hematologic malignancies in six cases

背景:单倍体造血干细胞移植面临着植入困难、造血重建慢、移植物抗宿主病重、免疫重建迟、致死性感染发生率高等诸多难题,如克服这些问题可使单倍体造血干细胞移植得以广泛推广应用。目的:观察单倍体移植治疗恶性血液病的疗效。方法:在单倍体移植时采用阿糖胞苷、马利兰、环磷酰胺、抗胸腺细胞球蛋白、甲基环已亚硝脲联合作为预处理方案,用环孢素A、麦考酚酸酯、抗胸腺细胞球蛋白、白细胞介素11及甲氨蝶呤联合预防急性移植物抗宿主病,治疗6例恶性血液病。结果与结论:全部患者完全植入,白细胞>1.0×109L-1中位时间为15.8(+12d^+20d),Ⅲ~Ⅳ度移植物抗宿主病的发生率为16.7%,中位随访时间34.7(13~63)个月,无复发,至今仍存活。结果提示单倍体移植治疗恶性血液病时,用阿糖胞苷、马利兰、环磷酰胺、抗胸腺细胞球蛋白、甲基环已亚硝脲联合作为预处理方案,用环孢素A、麦考酚酸酯、抗胸腺细胞球蛋白、白细胞介素11及甲氨蝶呤联合预防急性移植物抗宿主病是安全、有效的。

BACKGROUND：Haploidentical hematopoietic stem cell transplantation is confronted with many problems such as difficulty to implant,slow reconstitution,severe graft versus host disease,delayed immunologic reconstitution,and high incidence rate of lethal infection.To overcome these problems can widely use the transplantation of haploidentical hematopoietic stem cells.OBJECTIVE：To study the effect of haploidentical hematopoietic stem cell transplantation in treatment of hematologic malignancies.METHODS：We used cytosine arabinoside,busulphan,cyclophosphamide,the anti-thymocyte globulin and methyl-n-（2-chloroethlyl）-n-cyclohexyl-n-nitrosourea as preconditioning of patients,used cyclosporine A,mycophenolate mofetil,the anti-thymocyte globulin,interleukin-11 and methotrexate as prophylaxis of acute graft versus host diseases to treat 6 cases of hematologic malignancies.RESULTS AND CONCLUSION：All patients achieved complete engraftment.The median times of neutrophil recovery 1.0×109/L were 15.8（＋12-＋20） days after transplantation.The incidence of grade Ⅲ-Ⅳ graft-versus-host disease was 16.7%.All patients survived disease-free with a median follow-up of 34.7（13-63） months.Results have indicated that haploidentical hematopoietic stem cell transplantation is a safe and effective treatment for hematologic malignancies,with cytosine arabinoside,busulphan,cyclophosphamide,the anti-thymocyte globulin,methyl-n-（2-chloroethlyl）-n-cyclohexyl-n-nitrosourea as preconditioning,with cyclosporine A,mycophenolate mofetil,the anti-thymocyte globulin,interleukin-11 and methotrexate as prophylaxis of acute graft versus host diseases.