移植前肺部感染对造血干细胞移植疗效的影响

Effect of pulmonary infection on hematopoietic stem cell transplantation

目的观察移植前肺部感染对血液病造血干细胞移植疗效的影响。方法回顾性分析1999年8月-2012年3月我院21例血液病患者造血干细胞移植前出现肺部感染经治疗后接受造血干细胞移植的疗效,其中急性淋巴细胞白血病7例、急性非淋巴细胞白血病10例、骨髓增生异常综合征2例、急性再生障碍性贫血2例。接受异基因造血干细胞移植20例,1例接受自体造血干细胞移植。移植前肺部感染均为深部真菌感染或混合感染,抗真菌治疗后病灶消失或缩小至稳定时进行移植,肺部还有残存病症移植期间持续抗真菌治疗,病灶消失的预处理后给予抗真菌次级预防。结果 21例移植后28 d骨髓均增生活跃,骨髓像完全缓解,其中异基因造血干细胞移植嵌合体均为100%供者型。移植后14例未出现新的肺部感染,其中1例因白血病复发死亡;7例肺部感染加重,考虑为侵袭性深部真菌感染,经抗真菌治疗1~2个月后痊愈2例,显效3例;肺部感染恶化死亡2例,其中1例白血病复发。结论肺部感染的血液病患者经有效抗感染治疗,依然可以行造血干细胞移植;肺部真菌感染对造血干细胞移植成功率无明显影响。

Objective To observe the effect of pulmonary infection on hematopoietic stem cell transplantation.Methods Effect of hematopoietic stem cell transplantation on pulmonary infection in 21 patients with hematopathy admitted to our hospital from August 1999 to March 2012 was retrospectively analyzed.Of these 21 patients,7 were diagnosed as acute lymphocytic leukemia,10 as acute non-lymphocytic leukemia,2 as myeloproliferative syndrome,and 2 as acute aplastic anemia,and 20 received allogeneic hematopoietic stem cell transplantation and 1 received autologous hematopoietic stem cell transplantation.All the patients were diagnosed as deep fungal infection or mixed infection and underwent hematopoietic stem cell transplantation when their lesions disappeared or became smaller after anti-fungal therapy.Results Twenty-eight days after hematopoietic stem cell transplantation,the bone marrow proliferated actively in the 21 patients with their myelopathy completely alleviated.The chimera was 100% donor type after allogeneic hematopoietic stem cell transplantation.Fourteen days after hematopoietic stem cell transplantation,no new pulmonary infection occurred in 14 patients with 1 died of recurrent leukemia,pulmonary infection was exacerbated in 7 patients with 2 completely cured,3 significantly improved after antifungal therapy for 1-2 months and 2 died due to exacerbated pulmonary infection.Conclusion Hemapathy patients with pulmonary infection can undergo hematopoietic stem cell transplantation after effective anti-infection treatment.Pulmonary fungal infection shows no significant effect on hematopoietic stem cell transplantation.