150例异基因造血干细胞移植治疗恶性血液病的疗效分析

发布时间：2018-04-12 07:26

本文选题：造血干细胞移植 + 血液肿瘤　；参考：《重庆医学》2016年02期

【摘要】：目的分析异基因造血干细胞移植(allo-HSCT)治疗恶性血液病的疗效及安全性,探讨移植相关并发症及影响预后的因素。方法回顾性分析2010年6月至2015年6月贵州医科大学附属医院造血干细胞移植中心行allo-HSCT的150例恶性血液病患者的病历资料。按照供者类型不同,将其分为同胞全相合移植组(n=52)和单倍体移植组(n=98)。所有患者均采用改良白消安/环磷酰胺(BU/CY)为预处理方案,单倍体移植组加用兔抗人胸腺细胞免疫球蛋白(ATG),移植物抗宿主病(GVHD)的预防采用短疗程甲氨蝶呤+环孢素A+吗替麦考酚酯,对150例患者疗效、安全性及移植相关并发症进行分析。结果 150例患者经血型、染色体或DNA多态性检测证实均达到完全供者细胞植入,同胞全相合移植组平均中性粒细胞及血小板重建时间为移植后12d和16d,单倍体移植组平均中性粒细胞及血小板重建时间为移植后13d和16d。150例患者中,59例(39.3%)患者出现口腔黏膜溃疡,47例(31.3%)患者移植后100d内发生细菌和(或)真菌感染,41例(27.3%)患者移植后100d内发生巨细胞病毒感染,48例(32.0%)患者发生急性GVHD,43例(28.7%)患者发生慢性GVHD。随访1~60个月,中位随访时间23个月。115例(76.7%)患者无病存活,其中同胞全相合移植组38例(73.1%,38/52),单倍体移植组77例(78.6%,77/98)。35例(23.3%,35/150)患者死亡,其中同胞全相合移植组死亡14例(26.9%,14/52),单倍体移植组死亡21例(21.4%,21/98)。死因分析发现,12例(8.0%)因移植相关并发症死亡,其中5例(3.3%)因严重感染,7例(4.7%)因急性GVHD;23例(15.3%)患者因原发病复发死亡。两组患者生存率及死亡率比较差异无统计学意义(P0.05)。结论 allo-HSCT治疗恶性血液病安全有效,单倍体移植的疗效与安全性接近全相合移植,急性GVHD和感染是严重影响移植疗效和预后的危险因素,需早期预防。
[Abstract]:Objective to analyze the efficacy and safety of allo-HSCT in the treatment of malignant hematological diseases, and to explore the related complications and prognostic factors of allogeneic hematopoietic stem cell transplantation (HSCT).Methods from June 2010 to June 2015, the medical records of 150 patients with malignant hematologic diseases were retrospectively analyzed in the Hematopoietic Stem Cell Transplantation Center of affiliated Hospital of Guizhou Medical University.According to the type of donor, it was divided into two groups: sibling homozygous transplantation group and haploid transplantation group.All of the patients were treated with modified Baoxifen / Cyclophosphamide butadiene (BU / CYR) regimen.In the haploid transplantation group, the short course of methotrexate A motimicol ester was used in the prevention of rabbit anti-human thymocyte immunoglobulin (ATGG) and graft-versus-host disease (GV HDD). The efficacy, safety and transplantation related complications of 150 patients were analyzed.Results all the 150 patients were confirmed by blood type, chromosome or DNA polymorphism to be completely donor cell implantation.The mean mean neutrophil and platelet reconstruction time in the sib group was 12d and 16d after transplantation, and the mean neutrophil and platelet remodeling time in haploid group was 39.3% (59 / 13d).Bacterial and / or fungal infection was found in 41 patients within 100 days after transplantation. There were 48 patients with cytomegalovirus infection within 100 days after transplantation and 48 patients with cytomegalovirus infection.) 43 patients with acute GV HDV developed acute GV HDD (43 patients with GVHD) developed chronic GVHD.Among them, 14 cases died in the sibling complete homograft group (26.9%) and 21 cases in the haploid transplantation group (21 / 21 / 98).The causes of death were as follows: 12 cases (8.0%) died as a result of transplantation related complications, 5 cases (3.3%) and 7 cases (4.7%) due to severe infection) and 23 cases (15.3%) of acute GVHD) died of primary disease.There was no significant difference in survival rate and mortality between the two groups (P 0.05).Conclusion allo-HSCT is safe and effective in the treatment of malignant hematologic diseases, and the effect and safety of haploid transplantation are close to that of complete matching transplantation. Acute GVHD and infection are the risk factors which seriously affect the curative effect and prognosis of transplantation, and need to be prevented early.
【作者单位】：贵州医科大学附属医院血液科/贵州省造血干细胞移植中心;贵州省安顺市人民医院血液科;
【基金】：国家自然科学基金资助项目(81070444,81270636) 贵阳市科技局筑科合同(筑科合同[20141001]47号)
【分类号】：R457.7

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