抗CD25单抗与抗胸腺细胞球蛋白在半相合造血干细胞移植中疗效分析

Effective Comparison of Anti-CD25 Monoclonal Antibody and Anti-thymocyte Globulin on Haploidentical Hematopoietic Stem Cell Transplantation

目的探讨抗CD25单抗在半相合造血干细胞移植中的疗效及安全性。方法 2004年10月—2011年6月有18例白血病接受了人类主要组织相容性抗原(human leukocyte antigen,HLA)半相合造血干细胞移植。预处理采用改良白消安与环磷酰胺方案。根据移植物抗宿主病(GVHD)预防方案分为抗CD25单抗组及抗胸腺细胞球蛋白(ATG)组,每组9例。抗CD25单抗组为环孢素A+短疗程甲氨蝶呤+吗替麦考酚酯+抗CD25单抗,ATG组为环孢素A+短疗程甲氨蝶呤+吗替麦考酚酯+ATG。观察两组造血重建情况、急慢性GVHD发生情况、药物不良反应、复发及无病生存情况。结果两组均获稳定的造血重建,重建时间比较差异无统计学意义(P>0.05)。两组GVHD发生情况、复发及无病生存率比较差异均无统计学意义(P>0.05)。ATG组中有8例发生药物不良反应,抗CD25组未发生明显药物不良反应。结论在半相合造血干细胞移植中,以抗CD25单抗替代ATG预防GVHD疗效较好,不良反应少,可作为预防GVHD的一种有效方案。

Objective To explore curative effect and security of anti-CD25 monoclonal antibody on haploidentical hematopoietic stem cell transplantation.Methods A total of 18 patients with leukemia were performed related-human leukocyte antigen（HLA） haploidentical hematopoietic stem cell transplantation during October 2004 and June 2011.Pretreatment consisted of improved Busulphan and Cyclophosphamide.There were anti-CD25 monoclonal antibody group（group A,n = 9） and anti-thymocyte globulin（ATG） group（group B,n = 9） based on graft versus host disease（GVHD） preventive program.Ciclosporin A,short course of Methotrexate,Mycophenolate Mofetil and anti-CD25 monoclonal antibody were used to prevent GVHD in group A,while Ciclosporin A,short course of Methotrexate,Mycophenolate Mofetil and ATG were used in group B.Conditions of hematopoietic reconstitution,incidence rates of acute and chronic GVHD,adverse drug reactions,disease recurrence and disease-free survival rate of the two groups were observed.Results Hematopoietic reconstitutions were performed successfully in the two groups,and the difference in reconstitutions showed no statistical significance（P 0.05）.There were no statistical significances in incidence rate of GVHD,recurrence rate and disease free survival rate in the two groups（P 0.05）.In group B 8 patients had drug adverse reactions,but there was no obvious drug adverse reaction in group A.Conclusion Anti-CD25 monoclonal antibody for GVHD prevention may get better curative effect compared with ATG on haploidentical hematopoietic stem cell transplantation,which can have little adverse reaction.