化疗联合HLA不全相合G-PBSC输注治疗恶性血液病的临床分析

Clinical analysis of chemotherapy combined with HLA-mismatched G-PBSC infusion for hematologic malignancies

目的初步探讨化疗联合HLA不全相合G-PBSC输注(微移植)治疗恶性血液病的临床应用。方法回顾性分析2015-05～2016-12接受微移植治疗的13例恶性血液病患者的临床及随访资料。根据病情,对13例患者行不同的预处理方案化疗后,计划给予微移植3～4次。观察微移植后患者的缓解情况,生存时间,血象恢复时间,急、慢性移植物抗宿主病(GVHD)及其他不良反应发生情况。结果随访至2017-04,中危组8例,其中存活6例,死亡2例;高危组5例,其中存活2例,死亡3例。中位生存期为9个月(4～24个月)。微移植治疗后,中性粒细胞和血小板平均恢复时间分别为8 d(5～14 d)和11 d(6～20 d)。所有患者在微移植过程中均未出现急、慢性GVHD及其他不良反应。结论微移植在供者选择上不受限制,移植后血小板及中性粒细胞恢复较快,且无急、慢性GVHD及其他不良反应发生;微移植在中高危恶性血液病的临床应用尚处于探索阶段,仍需多中心、大样本的临床研究来进一步验证。

Objective To investigate the clinical efficacy of chemotherapy combined with HLA-mismatched G-PBSC infusion（microtransplantation） for hematologic malignancies. Methods 13 patients with hematologic malignancies received microtransplantation in our hospital from May 2015 to December 2016 and their clinical data were retrospectively analyzed. According to the different conditions, the 13 patients were treated with different conditioning regimens and then hematopoietic stem cell infusion was performed on them for 3 to 4 times. The recovery time of platelet and neutrophils, the occurrence of acute and chronic graft versus host disease（GVHD） and other adverse reactions were observed. Results During the follow-up that was conducted to April 2017, 6 cases survived and 2 cases died in the intermediate risk group（ n =8）; 2 cases survived and 3 died in the high risk group（ n =5）. The medium survival time was 9 months（4 to 24 months）. The recovery time of neutrophil and platelet was 8 days（5 to 14 days） and 11 days（6 to 20 days） respectively after microtransplantation. All the patients had no acute and chronic GVHD during microtransplantation. Conclusion Microtransplantation is unrestricted in the choice of donors, and the recovery time of platelet and neutrophils is shorter. No cases of GVHD is observed. Large randomized clinical trials of microtransplantation are needed to verify the results in the intermediate-risk and high-risk hematologic malignancies.