异基因造血干细胞移植后肠道移植物抗宿主病

Intestinal graft-versus-host disease after allogeneic hemapoietic stem cell transplantation

目的观察异基因造血干细胞移植(allo-HSCT)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 15例(6例急性髓系白血病,5例急性淋巴细胞白血病,3例慢性髓系白血病和1例多发性骨髓瘤)患者行allo-HSCT。预处理方案包括:4例氟达拉滨(Flu)+阿糖胞苷(Ara-c)+全身放疗(TBI)+环磷酰胺(CY)、5例TBI+CY+依托泊苷(VP-16)、2例TBI+CY、4例白消安(Bu)+CY。以环孢素A、霉酚酸酯、抗淋巴细胞球蛋白加短程甲氨蝶呤预防aGVHD。结果 15例患者发生肠道aGVHD的中位时间为移植后39(19-143)d,Ⅲ度aGVHD 8例,Ⅳ度aGVHD7例。经治疗,7例患者获得完全缓解,3例部分缓解,5例疗效欠佳,治疗总有效率为66.7%。结论肠道aGVHD是allo-HSCT后常见的最严重并发症之一,有效治疗直接关系到疾病的预后。

Objective To investigate the chnical characteristics,treatment and outcome of intestinal acute graft-versus-host diseases after allogeneic hemapoietic stem cell transplantation（aUo-HSCT）. Methods Fifteen patients （6 with acute myelocytic leukemia,5 with acute lymphocytic leukemia,3 with chronic myelocytic leukemia and I with multiple myeloma）underwent allo--HSCT. The conditioning regimens included Flu（fludarabine）＋Ara-C（cytarabine）plus TBI （ total body irradiation ） ＋ CY （ cyclophosphamide ） （n=4）, TBI＋ CY＋VP- 16 （etoposide） （ n=5 ）, TBI＋CY （ n=2 ） and Bu （busulfan） ＋CY （n=4）. The prevention of aGVHD included cyclosporine A,mycophenolate mofetil,anti-thymocyte globulin and short course methotrexate. Results The median time of aGVHD development was 39 （19-143）days after allo-HSCT. Eight patients developed grade Ⅲ intestinal aGVHD,and 7 developed grade Ⅳ aGVHD. Seven patients achieved complete remission,3 partial remission and 5 did not obtain response after treatment. The overall effective rate was 66.7%. Conclusions Intestinal aGVHD is one of the most common severe complications after allo--HSCT,and has an enormous impact on the survival rate of recipients after transplantation.