异基因外周血干细胞移植后GVHD的防治

THE PROPHYLAXIS AND TREATMENT OF GRAFT VERSUS HOST DISEASE IN ALLOGENEIC PERIPHERAL BLOOD STEM CELL TRANSPLANTATION

目的 研究 Allo- PBSCT治疗白血病时 GVHD发生状况 ,探讨其有效防治方法。方法 成年人白血病 13例 ,经预处理 (CTX12 m g/ kg- 1· d- 1 ,TBI9Gy～ 10 Gy)后移植 HL A相合的经 G- CSF3 0 0 μg/ d动员的外周血单个核细胞 10× 10 9/ kg;应用小剂量环孢菌素 A联合短程 MTX预防 GVHD。结果 GVHD发生率 5 3 .4 % ,其中 度以上 GVHD占 4 3 % (3 / 7) ,无直接死于 GVHD者。结论 PBSCT患者 GVHD发生率和严重程度没有明显增高 ,CSA血药浓度与 GVHD发生密切相关 ,NK细胞比例可能协助诊断 GVHD。

Objective To study clinical condition of graft uersus host disease(GVHD) in allogeneic peripheral blood stem cell transplantation.Methods Thirteen patients with leukemia were prepared for the transplantation with cyolophosphamide(120mg/kg) and TBI (9 to 10Gy) and received 10×10 8/kg peripheral blood mononucler cells mobilized by G CSF,For the prophylaxis of GVHD,All of the patients received CsA 1 2 mg/kg/d for continue infusion from day-1 to day +14,thereafter 5mg/kg/d for oral;MTX 15mg/d on day+1,MTX10mg/d on days+3、+6、+11 for infusion.Results GVHD rate was 53.4%,over Ⅱ°GVHD of them was 43% without patients died of GVHD.Conclusion Rate of GVHD is not higher in Allo PBSCT than in Allo BMT.Concentration of CsA is related with GVHD.Pecentage of NK cells may help for diagnosis of GVHD.