抗胸腺细胞球蛋白在同胞全相合异基因外周血造血干细胞移植中的应用

Myeloablative regimens including pretransplant antithymocyte globulin used in peripheral blood stem cell transplantation from HLA-identical sibling donors

目的 探讨抗胸腺细胞球蛋白（ATG）在同胞全相合异基因外周血造血干细胞移植（allo-PBSCT）中应用的可行性及价值.方法 57例血液系统恶性肿瘤患者行同胞全相合PBSCT,采用改良的Bu/Cy方案或TBI/Cy方案预处理,予ATG＋环胞菌素A（CsA）＋霉酚酸酯（MMF）＋短程甲氨蝶呤（MTX）预防移植物抗宿主病（GVHD）.结果 57例患者均达到稳定植活,急性GVHD（aGVHD）发生率为36.8%,其中Ⅰ～Ⅱ度aGVHD 31.6%,Ⅲ度aGVHD 5.2%,无Ⅳ度aGVHD发生.慢性GVHD（cGVHD）发生率为33.3%,其中2例表现为广泛型.38.6%患者在移植早期出现感染,50.9%患者出现巨细胞病毒（CMV）血症.5年总生存（OS）率及无病生存率（DFS）分别为71.35%和68.61%.结论 同胞全相合allo-PBSCT预处理阶段加用低剂量的ATG可能降低GVHD发生率,患者移植后淋巴增殖性疾病及机会感染发生率无明显增加,但可能增加高危患者的复发率.

Objective To explore the use of antithymocyte globulin in peripheral blood stem cell transplantation from HLA-identical sibling donors. Methods Fifty-seven adults with hematological malignancy were treated with a first myeloablative matched related donor peripheral blood stem cell transplantation with pretransplantation of ATG. All patients received modified Bu/cy conditioning regimen or Cy/TBI conditioning regimen. GVHD prophylaxis protocol included Rabbit ATG （thymoglobulin, genzyme）,Cyclosporin A, methotrexate and mycophenolate mofetil. Results All patients underwent engraftment with neutrophils and platelets. Incidence of aGVHD was 36.8 %. Gades Ⅰ - Ⅱ was observed in 31.6 %. Grade Ⅲ was 5.2 %. Grade Ⅳ was not seen. Incidence of cGVHD was 33.3 %, including two extensive cGVHD cases.Infection had occurred in twenty-two patients during transplantation. Twenty-nine （50.9 %） patients occurred CMV reactivation. The 5-year estimated OS is 71.35 %. The 5-year estimated DFS is 68.61%. Conclusion Pretransp