Outcomes of autologous bone marrow mononuclear cell transplantation in decompensated liver cirrhosis

AIM:To determine the long-term efficacy of autologous bone marrow mononuclear cells(BM-MNCs)transplantation in terms of improving liver function and reducing complications in patients with decompensated cirrhosis.METHODS:A total of 47 inpatients with decompensated liver cirrhosis were enrolled in this trial,including32 patients undergoing a single BM-MNCs transplantation plus routine medical treatment,and 15 patients receiving medical treatment only as controls.Fortythree of 47 patients were infected with hepatitis B virus.Bone marrow of 80-100 mL was obtained from each patient and the BM-MNCs suspension was transfused into the liver via the hepatic artery.The efficacy of BM-MNCs transplantation was monitored during a24-mo follow-up period.RESULTS:Liver function parameters in the two groups were observed at 1 mo after BM-MNCs transfusion.Prealbumin level was 118.3±25.3 mg/L vs 101.4±28.7 mg/L(P=0.047);albumin level was 33.5±3.6g/L vs 30.3±2.2 g/L(P=0.002);total bilirubin 36.9±9.7 mmol/L vs 45.6±19.9 mmol/L(P=0.048);prothrombin time 14.4±2.3 s vs 15.9±2.8 s(P=0.046);prothrombin activity 84.3%±14.3%vs 74.4%±17.8%(P=0.046);fibrinogen 2.28±0.53 g/L vs1.89±0.44 g/L(P=0.017);and platelet count 74.5±15.7×109/L vs 63.3±15.7×109/L(P=0.027)in the treatment group and control group,respectively.Differences were statistically significant.The efficacy of BM-MNCs transplantation lasted 3-12 mo as compared with the control group.Serious complications such as hepatic encephalopathy and spontaneous bacterial peritonitis were also significantly reduced in BM-MNCs transfused patients compared with the controls.However,these improvements disappeared 24 mo after transplantation.CONCLUSION:BM-MNCs transplantation is safe and effective in patients with decompensated cirrhosis.It also decreases the incidence of serious complications.

Autologous bone marrow transplantation in decompensated liver: Systematic review and meta-analysis

AIM:To evaluate the efficacy of autologous bone marrow mononuclear cell transplantation in decompensated liver disease.METHODS:Medline,EMBASE,PubMed,Science Direct,and the Cochrane Library were searched for relevant studies.Retrospective case-control studies were included along with randomized clinical trials.Metaanalysis was performed in line with recommendations from the Cochrane Collaboration software review manager.Heterogeneity was assessed using a randomeffects model.RESULTS:Four randomized controlled trials and four retrospective studies were included.Cell transplantation increased serum albumin level by 1.96 g/L(95%CI:0.74-3.17;P = 0.002],2.55 g/L(95%CI:0.32-4.79;P= 0.03),and 3.65 g/L(95%CI:0.76-6.54;P = 0.01)after 1,3,and 6 mo,respectively.Patients who had undergone cell transplantation also had a lower level of total bilirubin[mean difference(MD):-1.37 mg/dL;95%CI:-2.68-(-0.06);P = 0.04]after 6 mo.This decreased after 1 year when compared to standard treatment(MD:-1.26;95%CI:-2.48-(-0.03);P =0.04].A temporary decrease in alanine transaminase and aspartate transaminase were significant in the cell transplantation group.However,after 6 mo treatment,patients who had undergone cell transplantation had a slightly longer prothrombin time(MD:5.66 s,95%CI:0.04-11.28;P = 0.05).Changes in the model for endstage liver disease score and Child-Pugh score were not statistically significant.CONCLUSION:Autologous bone marrow transplantation showed some benefits in patients with decompensated liver disease.However,further studies are still needed to verify its role in clinical treatment for end-stage liver disease.

HIM_(1) AND HIM4, TWO MONOCLONAL ANTIBODIES POTENTIALLY USEFUL FOR AUTOLOGOUS BONE MARROW TRANSPLANTATION IN CHRONIC MYELOGENOUS LEUKEMIA

We developed two complement-fixing MoAbsHIMand HIM(murine)that were specifically reac-tive with chronic myelogenous leukemia (CML) cells.They were capable of fixing human or rabbit com-plement and suitable for CML cells purging of re-mission marrow from CML patients.HIMreactedwith majority leukemic cells form 7 out of 10 CMLpatients by complement-mediated cytotoxicity(C’MC)assay(positive cells 80%—90%),HIMreacted withmajority CML cells from 4 out of 5 CML by C’MCassay(positive cells 80%—90%).Treatment withHIMor HIMand human C’was capable of lysing97% of K562,U937,HL-60 and CML cells in a 20fold excess of unrelated cells by indirect FITC+EBstain.Using limited dilution culture,incubation withHIMand C’produced 1.5 logs inhibition of growthin K562 cells,and 1.9 logs in U937 cells,and withHIMand C’produced 2.9 logs inhibition in HL-60cells and 3.0 logs in U937 cells.Both MoAbs cocktailwas shown 1.8 logs in K562 cells and 3.2 logs in U937cells.They were no suppression on the growth o

Efficacy of corticosteroids injection and autologous bone marrow injection in the treatment of simple bone cyst in children: a meta-analysis

Objective: Evaluating the effectiveness of steroids and autologous bone marrow injection in the treatment of children with simple bone cysts. Methods: The literatures of Pubmed, CBM, CNKI, Wanfang Data, and VIP Database were compared in the database of corticosteroids injection and autologous bone marrow injection for the treatment of children with simple bone cysts. The literature was retrieved until June 2018. Read the abstract or full text of the literature carefully, track the references, evaluate the quality of the included literature and extract the data, and use Rev Man 5.3 for Meta-analysis. Results: There were five studies were included, a total of 246 children with simple bone cysts were enrolled in the study. Of these, 132 received percutaneous steroid injection and 114 received percutaneous autologous bone marrow injection. Comparison of percutaneous steroids injection with autologous bone marrow injection, there was no significant difference in overall cure rate (OR = 1.29, 95%, CI = 0.57~2.88, P = 0.54), incidence of pathological fractures after surgery (OR = 1.04, 95%, CI = 0.47~2.30, P = 0.92), and recurrence rate (OR = 3.24, 95%, CI = 0.96~10.96, P =0.06). Conclusion: There was no significant difference in the efficacy of percutaneous steroid injection and autologous bone marrow injection in the treatment of children simple bone cyst.

Effect of autologous bone marrow stem cells-scaffold transplantation on the ongoing pregnancy rate in intrauterine adhesion women:a randomized,controlled trial

Intrauterine adhesion is a major cause of female reproductive disorders.Although we and others uncontrolled pilot studies showed that treatment with autologous bone marrow stem cells made a few patients with severe intrauterine adhesion obtain live birth,no large sample randomized controlled studies on this therapeutic strategy in such patients have been reported so far.To verify if the therapy of autologous bone marrow stem cells-scaffold is superior to traditional treatment in moderate to severe intrauterine adhesion patients in increasing their ongoing pregnancy rate,we conducted this randomized controlled clinical trial.Totally 195 participants with moderate to severe intrauterine adhesion were screened and 152 of them were randomly assigned in a 1:1 ratio to either group with autologous bone marrow stem cells-scaffold plus Foley balloon catheter or group with only Foley balloon catheter(control group)from February 2016 to January 2020.The per-protocol analysis included 140 participants:72 in bone marrow stem cells-scaffold group and 68 in control group.The ongoing pregnancy occurred in 45/72(62.5%)participants in the bone marrow stem cells-scaffold group which was significantly higher than that in the control group(28/68,41.2%)(RR=1.52,95%CI 1.08–2.12,P=0.012).The situation was similar in live birth rate(bone marrow stem cells-scaffold group 56.9%(41/72)vs.control group 38.2%(26/68),RR=1.49,95%CI 1.04–2.14,P=0.027).Compared with control group,participants in bone marrow stem cells-scaffold group showed more menstrual blood volume in the 3rd and 6th cycles and maximal endometrial thickness in the 6th cycle after hysteroscopic adhesiolysis.The incidence of mild placenta accrete was increased in bone marrow stem cells-scaffold group and no severe adverse effects were observed.In conclusion,transplantation of bone marrow stem cells-scaffold into uterine cavities of the participants with moderate to severe intrauterine adhesion increased their ongoing pregnancy and live birth rates,and this therapy was relatively safe.

The effectiveness of the mononuclear fraction of autologous bone marrow in the treatment of experimental chronic limb ischemia

Objective To study of the effectiveness of using autologous mononuclear fraction of bone marrow for the treatment of chronic limb ischemia. Methods Results of autologous mononuclear fraction of bone marrow in 90 laboratory Wistar rats on a background of creating chronic limb ischemia was presented. Sampling was carried out from the bone marrow of the femur of the animal. The mononuclear fraction of bone marrow autologous 4 × 106 cells in a volume of 200 microliter were injected into the ischemic limb of the two points,in each of which 100 microliter:(1)Paravessel directly below the inguinal ligament at the level of the sacroiliac joint in the area of the anatomical location of collaterals in the projection of the internal iliac artery and its branches;(2)Intramuscularly in gastrocnemius muscle anterior-lateral surface of the middle third of the leg. Results In the experimental group of rats treated with autologous mononuclear fraction of bone marrow,the level of microcirculation compared with the intact group of animals on day 21 was higher than 6. 1% by day 28% ~ 31. 2%; compared with the control group-day 10 increased by 111% at day 21,85. 7% on day 28% ~ 97%. Conclusion Proposed method of treating pathogenically justified and can be recommended for use in clinical practice in the treatment of patients with chronic obliterating diseases of lower limb arteries.

Transplantation of autologous bone marrow mononuclear cells for patients with lower limb ischemia

Background Many treatment options for lower limb ischemia are difficult to apply for the patients with poor arterial outflow or with poor general conditions. The effect of medical treatment alone is far from ideal, especially in patients with diabetic foot. A high level amputation is inevitable in these patients. This study aimed to explore the effect of transplantation of autologous bone marrow mononuclear cells on the treatment of lower limb ischemia and to compare the effect of intra-arterial transplantation with that of intra-muscular transplantation. Methods In this clinical trial, 32 patients with lower limb ischemia were divided into two groups. Group 1 （16 patients with 18 affected limbs） received transplantation of autologous bone marrow mononuclear cells by intra-muscular injection into the affected limbs; and group 2 （16 patients with 17 affected limbs） received transplantation of autologous bone marrow mononuclear cells by intra-arterial injection into the affected limbs. Rest pain, coldness, ankle/brachial index （ABI）, claudication, transcutaneous oxygen pressure （tcPO2） and angiography （15 limbs of 14 patients） were evaluated before and after the mononuclear cell transplantation to determine the effect of the treatment. Results Two patients died from heart failure. The improvement of rest pain was seen in 76.5% （13/17） of group 1 and 93.3% （14/15） of group 2. The improvement of coldness was 100% in both groups. The increase of ABI was 44.4% （8/18） in group 1 and 41.2% （7/17） in group 2. The value of tcPO2 increased to 20 mmHg or more in 20 limbs. Nine of 15 limbs which underwent angiography showed rich collaterals. Limb salvage rate was 83.3% （15/18） in group 1 and 94.1% （16/17） in group 2. There was no statistically significant difference in the effectiveness of the treatment between the two groups. Conclusions Transplantation of autologous bone marrow mononuclear cells is a simple, safe and effective method for the treatment of lower limb ischemia, and the two approaches for the implantation, intra-muscular injection and intra-arterial injection, show similar results.

Efficacy of autologous bone marrow mononuclear cell transplantation therapy in patients with refractory diabetic peripheral neuropathy

Background:Owing to the multifactorial nature of the pathogenesis of diabetic peripheral neuropathy (DPN),conventional drug therapies have not been effective.The application of stem cells transplantation may be useful for the treatment of DPN.This study was designed to assess the safety and therapeutic effects of autologous bone marrow mononuclear cells (BMMNCs) transplantation on the treatment of refractory DPN.Methods:One hundred and sixty-eight patients with refractory DPN were recruited and enrolled in the study.They received intramuscular injection of BMMNCs and followed at 1,3,6,12,18,24,and 36 months after the transplantation.Clinical data,Toronto Clinical Scoring System (TCSS),and nerve conduction studies (NCSs) were compared before and after the transplantation.Results:The signs and symptoms of neuropathy were significantly improved after BMMNCs transplantation.The values of the TCSS scores at 1 month (9.68 ± 2.49 vs.12.55 ± 2.19,P<0.001) and 3 months (8.47 ± 2.39 vs.12.55 ± 2.19,P<0.001) after the treatment reduced significantly compared with the baseline value.This decrement remained persistent until the end of the study.The conduction velocity and action potential and sensory nerves were significantly improved after transplantation (3 and 12 months after the treatment vs.the baseline:motor nerve conduction velocity,40.24 ± 2.80 and 41.00 ± 2.22 m/s vs.38.21 ± 2.28 m/s,P<0.001;sensory nerve conduction velocity,36.96 ± 2.26 and 39.15 ± 2.61 m/s vs.40.41 ± 2.22 m/s,P<0.001;compound muscle action potential,4.67 ± 1.05 and 5.50 ± 1.20 μV vs.5.68 ± 1.08 μV,P<0.001;sensory nerve action potential,4.29 ± 0.99 and 5.14 ± 1.26 μV vs.5.41 ± 1.14 μV,P<0.001).No adverse event associated with the treatment was observed during the follow-up period.Conclusions:Autologous transplantation of BMMNCs may be an effective and promising therapeutic strategy for the treatment of refractory DPN.

The Impact of Pretransplant Disease Characteristics on the Outcome of Autologous Stem Cell Transplantation for Neuroblastoma with High-Risk Features: A Retrospective Model from a Limited Resources Country

High-risk neuroblastoma still has poor survival outcome. Improvement of outcome is attributed to the consolidation of chemotherapy by autologous bone marrow transplant. Further improvement of the outcome by tandem autologous transplant is followed by immune therapy. We aimed with this study to correlate initial disease characteristics with the outcome of transplanted high-risk neuroblastoma. A retrospective analysis was done for 73 transplanted patients. Patients were treated in Children’s Cancer Hospital Egypt from July 2012 to July 2015. Seventy patients received Busulphan/Melphalan conditioning. The 3-year overall survival (OS) and event-free survival (EFS) was 63.3% and 51.3%, respectively. Disease stage did not impact the OS and EFS, P = 0.54 and 0.62 respectively. Status of MYCN did not reflect statistically on outcome for tumors with amplified compared to nonamplified (EFS, 49% and 63.1%, respectively). Response after induction chemotherapy pointed that patients who had objective response (complete response, very good partial response and partial response) were better compared to those with less response with EFS and OS of 53.3% and 64.2% compared to 49.3% and 63.5%, respectively, which may indicate that chemo-sensitive tumors have better outcome. By the end of the study, twenty-seven patients relapsed, out of them 25 patients died. Pretransplant risk features for neuroblastoma was nullified by autologous stem cell transplant. The modest outcome observed, highlights some limitations that need to be sorted out in countries with limited resources. The introduction of immune therapy and tandem transplant is needed to achieve a better outcome, yet it adds to more financial burden.

Effect of intracoronary autologous bone marrow mononuclear cells transplantation on arrhythmia in canines

Objective To observe the survival and the differentiation of grafted bone marrow cells(BM-MNCs)in host myocardium.To observe whether BM-MNCs transplantation can potentially cause arrhythmia and whether the BM-MNCs transplantation can alter the spatial distribution of connexins,important mediator for arrhythmia gen-

自体骨髓干细胞移植治疗糖尿病足的效果观察

目的 探析对糖尿病足患者联合自体骨髓干细胞移植治疗的临床效果。方法 纳入某医院于2019年2月至2021年6月收治的100例确诊糖尿病足患者,遵循随机数字表设计原则将其分组并设为对照组和观察组,每组50例。2组同时给予常规糖尿病足治疗,观察组联合自体骨髓干细胞移植。比较2组患者临床疗效差异及不良反应情况。结果 观察组患者糖尿病足临床有效率(96.0%)显著高于对照组(82.0%),差异有统计学意义(P<0.05)。治疗前2组患者VAS、糖尿病足溃疡面积评价数据比较,差异无统计学意义(P>0.05),治疗后2组患者视觉疼痛模拟评分(VAS)、溃疡面积有所改善,观察组评价优于对照组,差异有统计学意义(P<0.05)。治疗后观察组患者创面肉芽组织中血管内皮生长因子(VEGF)(8 077.65±147.42)IOD、人基质衍生因子-1aSDF-1a(SDF-1a)(5 224.09±125.45)IOD、c-x-c趋化因子受体4型(CXCR4)(14 279.86±289.94)IOD水平显著高于对照组,2组比较差异有统计学意义(P<0.05)。2组患者治疗期间均无出现相关不良反应。结论 为收治糖尿病足患者联合自体骨髓干细胞移植方案效果显著,且安全可靠,值得临床推广。

自体外周血造血干细胞移植和自体骨髓移植治疗急性白血病疗效的比较

目的比较自体外周血造血干细胞移植(APBSCT)或者净化自体骨髓移植(PABMT)对急性白血病的疗效。方法回顾性分析2020年8月至2022年8月河南科技大学第一附属医院收治的86例急性白血病患者的临床资料,根据治疗方式不同分成对照组(采取PABMT治疗)、观察组(采取APBSCT治疗),各43例。比较两组临床疗效、造血恢复时间、住院时间及移植并发症出现情况。结果两组治疗后1个月及3个月的缓解率比较,差异无统计学意义(P>0.05)。观察组的白细胞>1×10^(9)/L、中性粒细胞>0.5×10^(9)/L、血小板>20×10^(9)/L时间和住院时间均短于对照组,差异有统计学意义(P<0.05)。两组各类移植并发症出现情况比较,差异无统计学意义(P>0.05)。结论APBSCT、PABMT对急性白血病的疗效相当,但后者采集方便,能迅速恢复造血,缩短患者的住院时间,值得采用。

叙事护理对宫腔镜下自体骨髓干细胞移植患者焦虑的影响

目的探究叙事护理对宫腔镜下移植自体骨髓干细胞患者焦虑的影响。方法将100例宫腔镜下自体骨髓干细胞移植患者随机分为对照组和观察组各50例。对照组开展常规护理干预,观察组在对照组基础上运用叙事护理。于入院时及出院当天采用焦虑自评量表(SAS)进行评价,出院时调查患者满意度。结果出院时观察组SAS评分显著低于对照组,患者满意度显著高于对照组(P<0.05,P<0.01)。结论叙事护理用于宫腔镜下移植自体骨髓干细胞患者,有助于改善其焦虑状况,提高患者满意度。

异体骨联合自体骨髓移植治疗骨囊肿

目的介绍异体骨联合自体骨髓移植治疗骨囊肿的手术方法。方法2004年2月～2006年3月,共收治骨囊肿13例,男6例,女7例;年龄5～16岁,平均11.5岁。其中肱骨近端5例,股骨颈2例,股骨干3例,胫骨上段2例,胫骨下段1例;合并病理性骨折5例。所有患者均行瘤体刮除、异体骨与自体骨髓联合移植术,8例加行器械固定术。结果术后5例切口期愈合;8例切口引流物150ml以上,其中5例切口渗液,3例伤口延期愈合。全部获随访6个月～2年,根据Capanne标准,术后X线片达级愈合10例,级3例,时间为3.5～8个月,平均5.2个月,无1例复发;未见再骨折发生;肢体功能基本恢复。结论异体骨联合自体骨髓移植治疗骨囊肿是一种安全有效的手术方法。

自体骨髓干细胞移植治疗严重下肢缺血5例

目的:观察自体骨髓干细胞移植治疗下肢严重缺血的疗效。方法:2003年3—8月,我们应用自体骨髓干细胞移植治疗5例下肢严重缺血。患者男性4例,女性1例;年龄51-81岁,平均71.5岁;其中有4例为糖尿病足坏疽或溃疡,1例为血栓闭塞性脉管炎。手术首先抽取自体骨髓350ml,在体外经过离心等处理后,分离出单个核细胞悬浊液约40ml,再在硬膜外麻醉下,进行小腿肌肉局部注射,其中第5例并进行了大腿和小腿联合移植。结果:5例患者全部得以保存下肢,有效率为100%;其中1例患者在入院时由于左足大部就已坏疽,且已达肌腱深度,不得不截去左足。疼痛缓解3例,1例血栓闭塞性脉管炎患者的肢体虽然仍有疼痛感,但经皮氧分压测定显示并不缺血;考虑与长期应用杜冷丁成瘾有关。患者下肢远端的经皮氧分压测定显示平均为30mmHg,高于截肢的临界值20mmHg,2例患者进行了下肢动脉造影复查,显示血管侧支建立非常丰富。结论:自体骨髓干细胞移植治疗下肢缺血性疾病是一种简单、安全、有效的方法。

自体骨髓单个核细胞移植治疗下肢动脉闭塞症

背景:下肢缺血性疾病治疗中血管再生技术已成为研究的热点。目的:观察自体骨髓单个核细胞移植后下肢缺血性疾病患者肢体缺血症状的改善情况。方法:东南大学医学院附属江阴医院胸心血管外科及南京大学医学院附属南京市鼓楼医院血管外科于2007年10月至2011年10月采用自体骨髓单个核细胞治疗35例下肢缺血性疾病患者,抽取自体骨髓单个核细胞,沿下肢动脉走行路径进行多点注射,测定患肢疼痛程度、冷感缓解程度、踝肱指数、经皮氧分压及皮肤溃疡或坏疽面积的改变,动脉造影观察血管新生情况。结果与结论:①疼痛评分:骨髓单个核细胞移植后2个月和1年的疼痛评分均较移植前有下降趋势,差异有显著性意义(P<0.05)。移植后2个月与移植后1年评分比较,差异无显著性意义(P>0.05)。②冷感缓解程度:移植后2个月缓解率为51%,移植后1年缓解率为60%,与移植前比较差异有显著性意义(P<0.05)。③踝肱指数的变化:移植2个月踝肱指数均较移植前有升高趋势,但差异无显著性意义(P>0.05),移植后1年踝肱指数较移植前有明显增高,差异有显著性意义(P<0.05)。④经皮氧分压的变化:对经皮氧分压增加值进行比较,移植后2个月及移植后1年均较移植前明显增加,差异有显著性意义(P<0.05),移植后1年与移植后2个月比较差异无显著性意义(P>0.05)。⑤行走距离:移植后2个月和移植后1年的行走距离明显增加,与移植前比较差异有显著性意义(P<0.05),移植后1年与移植后2个月比较差异无显著性意义(P>0.05)。⑥溃疡创面的变化:移植后2个月和1年的溃疡面积均较移植前有缩小趋势,差异有显著性意义(P<0.05)。⑦新生血管评价:移植后股动脉造影显示缺血下肢注射骨髓单个核细胞的部位毛细血管增生明显,且与已有的毛细血管相互连接形成侧支循环,促进了缺血下肢的血液供应。

自体骨髓干细胞移植与归元方联用治疗急慢性肝损伤实验研究

研究中药归元方与自体骨髓干细胞移植对急慢性肝损伤的治疗作用。研究方法 :用肝脏局部注射乙醇的方法复制急性局限性肝损伤模型 ,复合因素 (CCl4、乙醇、高脂、低蛋白 )刺激复制大鼠肝纤维化模型 ,通过定量组织学、肝功能检查、免疫组化、肝组织羟脯氨酸含量、损伤或纤维区骨髓干细胞观察等综合评价中药、自体骨髓干细胞移植及两者合用的疗效。结果 :归元方与自体骨髓干细胞移植可减小肝损伤区域 ,改善肝功能 ,使纤维肝组织表达 μPA增强 ,降低血清ALT ,AST ,PCⅢ ,HA和肝组织羟脯氨酸的含量 ,改善肝组织肝纤维化评分 ,骨髓干细胞能在肝损伤、肝纤维化形成环境中存活、增殖 ,并向肝细胞分化 ,表达肝脏特异的角蛋白CK18。结论 :归元方与自体骨髓干细胞移植对急慢性肝损伤有明确的治疗作用 ,两者合用可优势互补 ,协同增效。临床上有良好的应用前景。

树突状细胞介导的抗白血病效应的临床研究

肿瘤的免疫治疗作为恶性肿瘤综合治疗的重要组成部分,近年来受到了广泛的关注。树突状细胞(DC)是已知的功能最强的抗原呈递细胞,不仅能够激活自体的抗肿瘤免疫,同样能够提高异体免疫组织的抗肿瘤效应。为了探讨外周血来源的DC体外培养扩增和临床治疗的可行性和安全性,分析DC免疫治疗对于急性非淋巴细胞白血病自体骨髓移植患者长期生存的影响,利用CS3000Plus采集13例急性非淋巴细胞白血病自体骨髓移植后的病人的外周血单个核细胞,经过2周的体外培养后行DC免疫治疗,治疗后长期随访观察其无病生存时间。结果表明,无一例发现有与DC免疫治疗相关的严重不良反应;KaplanMeier生存分析结果为:DC组5年生存率为75.52%,非DC组5年生存率为45.71%,DC组在累计生存率上明显优于非DC组。结论:外周血来源的DC体外培养和临床治疗是安全可行的,急性非淋巴细胞白血病病人在自体骨髓移植术后应用DC免疫治疗延长了其无病生存时间,提高了长期生存率。

自体外周血造血干细胞联合自体骨髓移植治疗难治性淋巴瘤的临床分析

本研究通过回顾性分析自体外周造血干细胞移植、自体骨髓移植及二者联合移植在治疗难治性恶性淋巴瘤的疗效、毒副作用、造血和免疫功能恢复速度等临床方面的差异,总结归纳三种不同移植方式在治疗难治性淋巴瘤方面的优劣。68例难治性恶性淋巴瘤患者接受了大剂量放化疗结合自体造血干细胞移植治疗,其中10例患者为单一自体骨髓移植(autologous bone marrow transplantation,ABMT),46例患者为单一自体外周血造血干细胞移植(autologous peripheral blood hematopoietic stem cell transplantation,APBHSCT),12例患者为自体外周血造血干细胞联合自体骨髓移植(autologous peripheral blood hematopoietic stem cells transplantation combined with autologous bone marrow transplantation,APBHSCT+ABMT)。结果表明:ABMT、APBHSCT、APBHSCT+ABMT的治疗有效率和1、3、5年生存率分别为(90%和75%、57.1%、33.3%);(86.4%和74.4%、54.2%、38.1%);(83.3%和72.7%、55.6%、40%)。白细胞恢复时间分别为13天、11天、8天,血小板恢复时间分别为17天、14天、9天。在移植后3个月、6个月、1年时检测ABMT、APBHSCT、APBHSCT+ABMT患者T细胞亚群正常率分别为(0%、33.3%、60%),(10.8%、32%、73.9%),(27.3%、55.6%、85.7%)。结论:自体外周血造血干细胞联合自体骨髓移植与单一自体外周造血干细胞移植治疗难治性恶性淋巴瘤的临床疗效和毒副作用相当,但联合造血干细胞移植(APBHSCT+ABMT)患者的造血功能恢复略快,有利于拓宽年龄偏大和造血功能受损患者移植方式的选择。

经肝动脉自体骨髓干细胞移植治疗失代偿期肝硬化40例

目的探讨经肝动脉自体骨髓干细胞移植对肝硬化患者的治疗作用。方法选择肝硬化失代偿期患者40例,其中肝炎后肝硬化29例,酒精性肝病10例,血吸虫性肝硬化1例,年龄26～67岁,平均46岁。患者在无菌条件下,从髂后上棘抽取骨髓150～200ml,在体外分离纯化骨髓源性干细胞并制成10ml细胞悬液,其单个核细胞计数为3.6×108/ml～1.8×1011/ml,采用流式细胞仪技术检测CD34+的干细胞数为106/ml～109/ml。经肝动脉将上述10ml细胞悬液移植入肝脏,分别在移植后第第2、4、8周复查肝脏功能,观察实验室指标,临床症状及不良反应情况。结果移植后第4周,血浆白蛋白明显升高,由(30.89±4.78)g/L升至(36.18±6.13)g/L,ALT由术前(111.72±109.35)U/L降至(75.71±18.62)U/L,AST由术前(78.35±55.89)U/L降至(57.34±16.43)U/L;总胆红素水平在移植前后无显著性变化。上述结果表明骨髓干细胞移植后,患者肝脏功能明显改善,但黄疸指标变化不显著。干细胞移植后4周,凝血酶原时间(PT)逐渐下降,由术前(17.81±4.39)s降至(16.36±4.11)s,纤维蛋白原逐渐升高,由术前(2.02±0.96)g/L升至(2.36±0.89)g/L;表明骨髓干细胞移植治疗后患者凝血机制明显改善。干细胞移植对肝硬化失代偿期患者生存质量的影响:食欲改善、体力好转37例(92.5%),腹胀减轻33例(82.5%),腹水减少、下肢浮肿减轻35例(87.5%)。在全部40例患者中术中未发生严重并发症,术后近期无不良反应出现。结论自体骨髓干细胞移植治疗可使失代偿期肝硬化患者肝功能明显改善,治疗安全有效且副作用小,可作为中晚期肝硬化患者的临床治疗方案。