挽救性二次异基因造血干细胞移植治疗复发的恶性血液病临床分析

发布时间：2018-01-28 22:35

  本文关键词： 挽救性 二次移植 异基因造血干细胞移植 复发难治 恶性血液病　出处：《苏州大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：观察挽救性二次异基因造血干细胞移植治疗16例移植后复发的恶性血液病的疗效。方法：选取苏州大学附属第一医院自2010年10月至2015年01月期间进行挽救性二次异基因造血干细胞移植治疗16例移植后复发的恶性血液病患者进行疗效分析。其中急性髓系白血病8例,急性淋巴细胞白血病2例,恶性淋巴瘤6例。首次移植情况：13例行自体外周血干细胞移植,2例行无关全相合移植,1例行同胞全相合移植,在移植后1～60个月复发。复发后采取的挽救性移植类型：单倍体半相合移植8例,同胞全相合移植3例,同胞8/10相合1例,无关供体移植4例。预处理方案为：含全身照射TBI联合CTX方案或者改良BuCy。GVHD预防方案为环孢素A(CSA)、麦考酚酸酯(MMF)、抗胸腺细胞球蛋白(ATG)、及甲氨蝶呤(MTX)。结果：16例患者完全植入,移植后中性粒细胞(0.5×10E9/L)恢复平均时间为12(9～16)d,PLT(20×10E9/L)恢复平均时间为15(12～60)d。Ⅱ～Ⅳ度急性GVHD发生率为40.0%,3例发生慢性GVHD。随访观察：9例存活,5例住院期间死亡,2例随访期间死亡,死亡原因分析：3例死于重症感染,均为败血症合并肺部感染；3例死于急性GVHD:分别为肠道GVHD及肝脏合并肠道GVHD 1例死于慢性GVHD。无事件生存率29%,总体生存率(OS)为56%。结论：挽救性二次异基因造血干细胞移植可以改善难治复发性恶性血液病的总生存率和无事件生存率,为初次移植后复发患者的治疗选择之一。
[Abstract]:Objective: to observe the therapeutic effect of salvage secondary allogeneic hematopoietic stem cell transplantation on 16 cases of recurrent malignant hematological diseases after transplantation. From October 2010 to January 2015, the first affiliated Hospital of Suzhou University was selected to carry out salvage secondary allogeneic hematopoietic stem cell transplantation for the treatment of 16 patients with recurrent malignant hematological diseases after transplantation. Among them, 8 cases were acute myeloid leukemia. There were 2 cases of acute lymphoblastic leukemia and 6 cases of malignant lymphoma. The types of rescue transplantation were haploid haploidentical transplantation in 8 cases, sibling homozygous transplantation in 3 cases and sib 8/10 matching in 1 case. No donor transplantation was performed in 4 cases. The pretreatment regimen included TBI combined with CTX or modified BuCy.GVHD prophylaxis with cyclosporine, mycophenolate mofetil (MMF). Results the antithymocyte globulin (ATGG) and methotrexate (MTX) were implanted completely in 16 patients. The average recovery time of neutrophil neutrophils was 12 ~ (9) / L ~ (-1) 脳 10 E ~ (9 / L) per day. The average recovery time of PLT(20 脳 10E9 / L was 15 ~ 120.The incidence of acute GVHD in grade 鈪，

本文编号：1471735