非清髓性异基因外周血造血干细胞移植

Analysis of the infectious complications following nonmyeloablative allogeneic peripheral blood stem cell transplantation

目的 总结非清髓性异基因外周血造血干细胞移植 (NASCT)治疗白血病的经验。方法 对 10例白血病患者进行非清髓性预处理 ,预处理采用氟达拉滨 (或环磷酰胺 )、抗淋巴细胞球蛋白及白消安 ,然后施行NASCT。术后预防移植物抗宿主病 (GVHD)采用环孢素A(CsA)加短程甲氨蝶呤 (MTX)。结果 中性粒细胞于术后第 10～ 38d超过 0 .5× 10 9/L ,血小板于第 8～ 16d上升至 2 0× 10 9/L以上 ;4例患者具有 10 0 %供者细胞 ,6例为嵌合性植入 ;2例发生急性GVHD ,5例发生慢性GVHD ;3例发生细菌感染 ,2例发生巨细胞病毒感染 ,1例发生疱疹病毒感染 ,均治愈 ;1例患者死于白血病复发 ,2例患者死于多器官功能衰竭 ,5例患者完全缓解 ,2例患者部分缓解。结论 NASCT后造血功能恢复迅速 ,是治疗白血病的有效方法。

Objective To investigate the infectious complications after nonmyeloablative allogeneic peripheral blood stem cell transplantation (NASCT). Methods Ten patients with leukemia received NASCT from HLA-identical or 1-3 antigen mismatched sibling donors with conditioning regimens of Flu/Cy+BU+ALG. Five patients were acute leukemia (AL) and all of them is in complete remission (CR1). Cyclosporine in combination with methotrexate was administered for GVHD prophylaxis. Results WBC recovered to more than 0.5 ×10 9/L during postoperative 10 day to 38 day and platelet recovered to more than 20×10 9/L during postoperative 8 day to 16 day. Bacterial infections occurred in 3 patients (30 %) and cytomegalovirus (CMV) infections in 2 patients (20 %). Varicella zoster virus (VZV) infections occurred in one patient (10 %). No fungal infections were documented. No patients died as a result of infection . Conclusion NASCT is a safe and effective therapeutic method for leukemia. It reduces acute GVHD,regimen-related toxicity and early neutropenia associated with traditional allo-HSCT.