异基因造血干细胞移植后肠道急性移植物抗宿主病24例临床分析

Clinical analysis of 24 patients with intestinal graf-versus-host disease after allogeneic hemapoietic stem cell transplantation

目的观察异基因造血干细胞移植术后肠道急性移植物抗宿主病(aGVHD)的临床特征、治疗及转归。方法 24例患者中7例接受同胞间白细胞抗原(HLA)全相合造血干细胞移植、17例接受HLA半相合造血干细胞移植,预处理方案依据具体情况选择FBA(氟达拉滨、白消安、阿糖胞苷)、Bu/Cy(白消安/环磷酰胺)、CCNU+Bu+CTX(环磷酰胺)+Ara-c(阿糖胞苷)+ATG、IFBA(伊达比星、氟达拉滨、白消安、阿糖胞苷)+ATG方案,采用环孢素A(CsA)联合短疗程甲氨蝶呤(MTX)及吗替表考芬兮酯(MMF)预防GVHD。结果 24例患者发生肠道aGVHD的中位时间为移植后24d,Ⅲ度aGVHD 2例,Ⅳ度aGVHD 22例;经治疗,15例患者症状缓解,9例疗效欠佳。结论肠道aGVHD临床症状重,预后差,需早期诊断及治疗。

Objective To investigate the feature, treatment and outcome of severe intestinal acute graft-versus-host disease （aGVHD） after allogeneic hemapoietic stem cell transplantation（Allo-HSCT）. Methods Seven patients received PBSCT from their HLA matched haploidentical siblings and seventeen patients received PBSCT/BMT from their HLA dismatched unrelated donors or haploidentical siblings or other relative. Twenty-four patients were pre-conditioned by different regimen which was determined on a ease-by-case basis. The. prevention of acute graft-versus-host disease （aGVHD） included cyclosporin A （CsA）,mycophenlate mof- etil （MMF） ,and short course of methotrexate （MTX）. Results Twenty-four patients developed intestinal aGVHD including two cases with grade Ⅲ and twenty-two cases with grade Ⅳ ,and the mean time of aGVHD development was 24 days after Allo-HSCT. The symptoms of fifteen patients were relieved while that of nine patients unrelieved after treatment. Conclusion Patients with in- testinal aGVHD have serious symptoms and poor prognosis. The early diagnose and treatment are necessary for intestinal aGVHD after transplantation.