异基因造血干细胞移植治疗恶性血液病(附9例报告)

Allogeneic hematopoietic stem cell transplantation for hematologic malignancies

9例恶性血液病患者 ,采用异基因外周血干细胞移植 ( allo- HSCT)治疗 7例 ,外周血与骨髓干细胞混合移植 2例 ;供者均为人白细胞相关抗原 ( HL A)完全相合同胞兄妹。预处理方案用马利兰 ( BU)、环磷酰胺( CY) ,环孢霉素 A ( Cs A)联合短程甲氨蝶呤 ( MTX)预防移植物抗宿主病 ( GVHD)。结果 :患者治疗后均重建造血 ,中性粒细胞≥ 0 .5× 10 9/ L 的中位数为 14天 ,血小板≥ 2 0× 10 9/ L 的中位数为 16天。发生急性 GVHD5例 ,慢性 GVHD2例 ,肝静脉闭塞病 ( VOD) 1例 ,巨细胞病毒血症 9例。2例 ABO血型不合者移植后未发生溶血及纯红再障。1例耐药复发淋巴瘤 ,供、受者均为乙肝病毒携带者 ,移植后达完全缓解。中位随访时间 15个月 ,无病生存 8例。认为 allo- HSCT是治疗恶性血液病 (尤其是耐药复发者 )的有效方法 。

7 patients with hematologic malignancies were treated by allogeneic peripheral blood stem cell transplantation(allo HSCT)and 2 patients were treated with PBSCT and bone marrow transplantation(BMT) The donors were HLA identical siblings Conditioning regimen was BU/CY A combination of cyclosporine and methotrexate was administered to prevent graft versus host disease(GVHD) The results showed all the patients were engrafted and hematopoietic reconstitution was rapid:neutrophils achieving 0 5×10 9/L on day 14,platelets≥20×10 9/L on day 16 Acute GVHD occurred in 5 patients and chronic GVHD in 2 patients 1 patient developed veno occlusive disease(VOD) All the 9 patients developed CMV infection The mixed transplantations of BM and PBSC was applied in 2 patients whose ABO blood type mismatched No hemolytic reaction and pure red aplastic anemia occurred Drug resistant relapse occurred in 1 patient with malignant lymphoma HBV was taken along by receptor and donor After allo HSCT there was a complete remission The median follow up duration was 15 months 8 patiants were alive in disease free situation This suggests allo HSCT is the most effective way for treating hematologic malignancies,especially for the patients who have no complete remission to the routine chemotherapy drug resistant The mismatched blood type of ABO and donors of hepatitis B are not the obstacle to transplantation