异基因造血干细胞移植急性移植物抗宿主病的预防措施

Prophylaxis of acute graft versus host disease in allogenic hematopoietic stem cell transplantation

目的 探讨异基因造血干细胞移植（Allo-HSCT）治疗恶性血液病时急性移植物抗宿主病（aGVHD）的预防策略.方法 对15例异基因造血干细胞移植患者联合采用重组人粒细胞集落刺激因子（rhG-CSF）动员,-7 d（回输干细胞前为-,回输后为＋,回输时为0）始环孢素静脉滴注、麦考酚吗乙酯口服;-5～-4 d环磷酰胺静脉滴注,-5 d～-2 d抗胸腺细胞球蛋白静脉滴注;-6 d～＋10 d白细胞介素11（IL-11）皮下注射;＋1 d、＋3 d、＋6 d及＋11 d甲氨蝶呤静脉滴注预防aGVHD.结果 15例患者完全植入,aGVHDⅡ～Ⅳ度的发生率20.0%,Ⅳ度的发生率6.7%,随访中位时间为30.7（4～65）个月,无复发,无恶性血液病存活.结论 异基因造血干细胞移植治疗恶性血液病时联合采用含有rhG-CSF、环孢素、麦考酚吗乙酯、环磷酰胺、抗胸腺细胞球蛋白、IL-11及短程甲氨蝶呤的方案预防aGVHD疗效可靠,值得推广.

Objective To study the prophylaxis of acute graft versus host disease in hematopoietic malignancy patients with allogenic hematopoietic stem cell transplantation. Methods In 15 cases of allogenic hematopoietic stem cell transplantation, we adopted prophylaxis include recombinant human granulocyte colony stimulating factor（rhG-CSF） to mobilize donor stem cell, cyclosporine A （GSA） infusion and mycophenolate mofetil （MMF） oral from -7 d（ ＂-＂ means befor infusion of donor stem cell, ＂＋＂ means after infusion of donor stem cell）, cyclophosphamide （CTX） infusion during - 5- - 4 d, anti-thymocyte globulin （ATG） infusion during - 5 d- - 2 d, interleukin 11（IL-11 ） subcutaneous injection during -2 d- ＋ 10 d, methotrexate（MTX） infusion at ＋1 d, ＋3 d, ＋6 d and ＋ 11 d to prevent aGVHD. Results All 15 cases achieved complete implantation. The incidence of aGVHD Ⅱ～Ⅳ degree was 20%. The incidence of aGVHD Ⅲ-Ⅳ degree was 6.7%. Median follow-up time was 30. 7（4-65）months. There was no relapse. All patients were hematopoietic malignancy free survival. Conclusion It is an effective prophylaxis and worth of spreading to prevent GVHD in hematopoietic malignancy patients with allogenic hematopoietic stem cell transplantation that combined uses rhG-CSF, GSA, MMF, CTX, ATG, IL-11, and shortterm MTX.