低剂量ATG用于父母HLA 10/10相合造血干细胞移植患者的临床分析

Clinical analysis of parental HLA 10/10 matched peripheral blood hematopoietic stem cell transplantation preconditioned by low-dose ATG

目的：探讨父母HLA 10/10相合不去除T细胞的外周血造血干细胞移植治疗恶性血液病的植入情况、疗效和相关并发症。方法：预处理采用改良的Bu/Cy方案,用低剂量的兔抗人T淋巴细胞球蛋白、环孢素A、吗替麦考酚酯和短程甲氨蝶呤预防移植物抗宿主病（GVHD）。回输G-CSF动员的外周血干细胞,输注单个核细胞中位数为7.830（7.320~10.004）×108/kg,CD34＋细胞中位数为4.59（3.68~5.32）×106/kg。结果：4例患者均达完全供者植入,粒系植入时间为16（11~16）d,血小板植入时间为22（11~29）d。发生Ⅱ度急性GVHD1例,发生率25%。发生慢性GVHD 3例,广泛型1例。中位随访267（178~1903）d,死亡1例（非复发死亡）,复发1例（为高危患者）,无复发存活2例。结论：低剂量ATG用于父母HLA 10/10相合供者异基因造血干细胞移植治疗高危恶性血液病是比较安全、有效的方案。

Objective：To explore theengraftment,efficacy and related complications of parental human leukocyte antigen（HLA）10/10 matched peripheral blood hematopoietic stem cell transplantation（PBHSCT）without T-cell depletion in 4patients with hematological malignancies.Method：All patients were preconditioned by the modified Bu/Cy regimen.GVHD prophylaxis consisted of low-dose antithymocyte globulin（ATG）,cyclosporin A,MTX and MMF（mycophenolatmofetil）.The dose of infused CD34 positive cells and mononuclear cells mobilized with G-CSF was 4.59（3.68-5.32）×106/kg and 7.83（7.32-10.00）×108/kg,respectively.Result：Granulocyte and thrombocyte engraftment of all patients were achieved on the 16th（range,11-16th）day and 22th（range,11-29th）day,respectively.One patient（25%）developed gradeⅡ aGVHD.And cGVHD was found in three patients（75%）,one of which experienced extensive cGVHD.The median follow-up was 267days（range,178-1 903days）.One patient died of non-relapse reasons,one patient relapsed and the other two patients survived well without recurrence.Conclusion：Parental HLA 10/10 matched PBHSCT preconditioned by low-dose ATG is an effective method for high risk patients with hematological malignancies.