异基因外周血造血干细胞移植及其联合骨髓移植后造血重建及移植物抗宿主病的比较

Comparison of time of hematopoietic reconstitution and incidence of GVHD between patients after allogeneic PBSCT and PBSCT combined with BMT

通过比较异基因外周血造血干细胞移植(PBSCT)与其联合骨髓移植(BMT)治疗白血病过程中造血重建时间、移植物抗宿主病(GVHD)发生率及生存率,探讨二者联合移植对白血病治疗的影响。回顾性分析2003年1月至2009年1月在郑州大学第一附属医院接受全相合异基因造血干细胞移植的152例患者,其中78例单纯接受外周血造血干细胞移植,74例接受外周血造血干细胞移植联合骨髓移植。预处理方案:152例患者均应用改良Bu/CY方案预处理,环孢素A(CsA)联合甲氨蝶呤(MTX)、吗替麦考酚酯(MMF)预防GVHD,流式细胞仪测定外周及骨髓造血干细胞计数。SPSS17.0统计分析两组患者移植后造血重建时间、GVHD的发生率及2年生存率。结果:1、移植后造血重建:接受外周血造血干细胞移植与联合骨髓移植患者的白细胞及血小板重建时间无显著性差异(血小板>20×109/L时间分别为(14.18±4.713)d和(12.55±6.552)d(P>0.05),中性粒细胞>0.5×109/L的时间分别为(12.08±3.586)d和(11.64±5.540)d(P>0.05);2、GVHD:接受PBSCT及联合BMT患者Ⅲ度到Ⅳ度急性GVHD(aGVHD)发生率比较有显著性差异(P=0.05)。两者慢性GVHD(cGVHD)发病率有显著性差异(P=0.01);3、2年生存率:接受外周血干细胞移植及其联合骨髓移植患者2年无病生存率和总生存率无显著性差异(P>0.05)。提示,异基因造血干细胞移植与其联合骨髓移植比较造血重建时间及2年生存率无明显差异,但前者GVHD发生率较高,因此外周血造血干细胞移植联合骨髓移植可能减少急性及慢性GVHD的发生。

To explore impacts of treatment for leukemia,by comparing the time of hematopoietic reconstitution,the incidence of GVHD and survival after allogeneic PBSCT and PBSCT combined with BMT.A total of 152 patients received allogeneic hematopoietic stem cell transplantation at the first affiliated hospital of Zhengzhou university from January 2003 to January 2009,of whom 78 received PBSCT,and 74 received PBSCT combined with BMT.Pretreatment schemes： All patients were adopted in modified Bu/CY conditioning regimen,CsA combined with MTX and MMF to prevent GVHD.Flow cytometer was used to count the peripheral blood and bone marrow stem cell.SPSS17.0 analyzed the time of hematopoietic reconstitution,incidence of GVHD and 2-year survival.Results：（1）Hematopoietic reconstitutions after transplantations： There were no significant differences in white blood cells and platelet reconstruction of patients after PBSCT and PBSCT combined with BMT,（Platelets 20×109 / L,time was 14.18±4.713 days and 12.55±6.552 days respectively,P 0.05;The time of neutrophils 0.5×109 / L was 12.08±3.586 days and 11.64±5.540 days respectively,P0.05）.（2）GVHD： There was a significant difference incidence of Ⅲ to Ⅳ Grade aGVHD of patients after PBSCT and PBSCT combined with BMT（P=0.05）.There was significant difference in incidence of cGVHD between the two groups（P=0.01）.（3）2-year survival rate： There were no significant differences in the 2-year disease-free survival rate and total survival in patients after PBSCT and PBSCT combined with BMT.Though there was not significant difference in hematopoietic reconstitution and 2-year survival rates between the patients after PBSCT and PBSCT combined with BMT,but the former had a higher incidence of GVHD.Therefore,PBSCT combined with BMT may reduce the incidence of acute and chronic GVHD.