外周血造血干细胞移植治疗重型再生障碍性贫血23例分析

Hematopoietic stem cell transplantation for 23 patients with severe aplastic anemia

目的:探讨外周血造血干细胞移植(HSCT)治疗重型再生障碍性贫血(SAA)的疗效。方法:回顾性分析23例接受外周血HSCT治疗的SAA患者的植活情况、移植物抗宿主病(GVHD)和移植相关并发症发生情况及影响预后的因素等。结果:23例患者中,22例造血重建,白细胞和血小板中位植活时间分别为移植后15(7～21)d、19(7～32)d,其中4例患者出现急性GVHD,发生率为18.2%(4/22),3例出现慢性GVHD,发生率为13.6%(3/22);1例未植活死亡,总体生存率为95.7%(22/23)。22例造血重建患者中,移植后发生巨细胞病毒感染4例,有出血表现8例,出血性膀胱炎1例,肺部感染7例,口角疱疹1例,化脓性扁桃体炎1例。另外,移植前有无感染及诊断到移植的间隔时间是影响患者预后的危险因素。结论:HSCT是治疗SAA的有效方法,加强移植前后的免疫抑制剂治疗,预防和控制感染,能有效地减少GVHD的发生,改善预后。

Objective：To explore the efficacy of hematopoietic stem cell transplantation（HSCT） in treating severe aplastic anemia（SAA）. Method：We retrospectively analyzed the effectiveness,graft-versus-host diseases（GVHD）,transplant-related complications and factors affecting the prognosis of 23 patients with SAA who received HSCT. Result：Twenty-two patients achieved hematopoiesis reconstitution.The median graft survival time of white blood cells and platelets were 15（7-21） days and 19（7-32） days,respectively.Four patients（18.2%） developed acute GVHD and 3 cases（13.6%） developed chronic GVHD.One patient died of un-engraftment,and the overall survival rate was 95.7%.As for the complications,CMV infection was found in 4 patients after HSCT,bleeding manifestations was in 8 cases,hemorrhagic cystitis was in 1 case,pulmonary infection was in 7 cases,mouth herpes in 1 case and suppurative tonsillitis was in 1 case.Moreover,infections before HSCT and the time interval from diagnosis to transplantation were risk factors influencing the prognosis. Conclusion：HSCT is an effective approach for patients with SAA.Enhancing immunosuppressive therapy before and after HSCT,and prevention and control of the infection can effectively reduce the incidence of GVHD and improve the prognosis.