同胞全相合、无关供体全相合及亲缘间单倍型异基因造血干细胞移植治疗伴有费城染色体急性淋巴细胞白血病:疗效和安全性

发布时间：2018-06-10 05:04

本文选题：费城染色体 + 前体细胞淋巴母细胞白血病淋巴瘤　；参考：《中国组织工程研究》2017年25期

【摘要】：背景:随着移植方案的优化及移植物抗宿主病治疗药物的出现,使得异基因造血干细胞移植近年来取得了巨大的进步,为越来越多的恶性血液病患者争取了长期生存的机会。目的:比较3种移植方式即同胞全相合、无关供体全相合及亲缘间单倍型异基因造血干细胞移植治疗伴有费城染色体急性淋巴细胞白血病(Ph+ALL)的疗效和安全性。方法:2006年6月至2013年11月间,69例伴有费城染色体急性淋巴细胞白血病患者接受异基因造血干细胞移植。同胞全相合移植23例,无关供体全相合移植24例,亲缘间单倍型移植22例;其中54例为CR1状态,12例为CR2到CR4状态,3例复发状态。获取供者骨髓干细胞或者外周血干细胞用于移植。预处理方案为阿糖胞苷、白消安、环磷酰胺及全身照射等。联合使用环孢素A+短程甲氨蝶呤+吗替麦考酚酯+抗人胸腺细胞球蛋白等预防移植物抗宿主病。结果与结论:(1)68例患者获得造血重建,仅1例单倍型植入失败;(2)患者随访时间中位数为20.4个月,同胞全相合、无关供体全相合及亲缘间单倍型移植的急性移植物抗宿主病发生率分别为30%,33%及45%,慢性移植物抗宿主病发生率22%,29%及36%,各组间急性移植物抗宿主病、慢性移植物抗宿主病发生率比较差异无显著性意义;(3)同胞全相合、无关供体全相合及亲缘间单倍型移植的移植相关死亡率为9%,29%及41%,各组间比较差异有显著性意义(0.01P0.05)。复发率为17%,21%及14%,各组间比较差异无显著性意义;(4)同胞全相合、无关供体全相合及亲缘间单倍型移植的3年总体生存率为68%,49%及43%,同胞全相合组与无关供体全相合组、同胞全相合与亲缘单倍型组分别比较,差异有显著性意义(P均0.05),而无关供体全相合与亲缘间单倍型移植比较差异无显著性意义;(5)54例CR1状态移植患者3年总体生存率为58%;15例于非CR1状态移植患者3年总体生存率为41%;(6)结果表明,同胞全相合移植疗效优于无关供体全相合及单倍型移植;CR1状态下行异基因造血干细胞移植的疗效显著优于CR2以上状态。
[Abstract]:Background: with the development of graft versus host disease (GVHD) therapy, allogeneic hematopoietic stem cell transplantation (HSCT) has made great progress in recent years. Objective: to compare the efficacy and safety of allogeneic hematopoietic stem cell transplantation with allogeneic haplotype in the treatment of Philadelphia chromosome acute lymphoblastic leukemia (Ph ALL). Methods: from June 2006 to November 2013, 69 patients with Philadelphia chromosome acute lymphoblastic leukemia received allogeneic hematopoietic stem cell transplantation. There were 23 cases of sibling homozygous transplantation, 24 cases of unrelated donor complete matching transplantation, 22 cases of allogeneic haplotype transplantation, among which 54 cases were CR1 status and 12 cases were CR2 to CR4 status. Obtain donor bone marrow stem cells or peripheral blood stem cells for transplantation. The pretreatment regimen was cytarabine, salicylate, cyclophosphamide and whole body irradiation. Combined use of cyclosporine A short course methotrexate against human thymocyte globulin was used to prevent graft-versus-host disease. Results the median follow-up time was 20.4 months in 68 patients with hematopoietic reconstitution and only one patient with haplotype failed implantation. The incidence of acute graft-versus-host disease was 30% and 45% in unrelated donors and haplotypes transplantation respectively, and the incidence of chronic graft versus host disease was 22 9% and 36%, respectively. Acute graft-versus-host disease was found in each group. There was no significant difference in the incidence of chronic graft-versus-host disease. There was no significant difference in the incidence of chronic graft-versus-host disease. There was no significant difference between the two groups. The transplant mortality of unrelated donors and haplotypes were 9% and 41%, respectively. There was a significant difference between the two groups (0.01 P 0.05). The recurrence rate was 17% and 14%. There was no significant difference between the two groups. The overall survival rate of unrelated donors and unrelated haplotypes was 6849% and 43% respectively. The sibling homozygous and relative haplotypes were compared, There was no significant difference between donor complete matching and allogeneic haplotype transplantation. There was no significant difference in 3-year survival rate of 554 CR1 patients with CR1 status transplantation. The overall 3-year survival rate of 15 patients with non-CR1 status transplantation was 58.15 patients with non-CR1 status transplantation had a 3-year overall survival rate. The survival rate was 41 / 6). The therapeutic effect of sibling homozygous transplantation was better than that of allogeneic hematopoietic stem cell transplantation under CR1 condition.
【作者单位】：苏州大学附属第一医院江苏省血液研究所卫生部血栓与止血重点实验室血液学协同创新中心;苏州市市立医院ICU;
【基金】：江苏省科教兴卫工程-临床医学中心(ZX201102) 国家临床重点专科建设项目卫生公益性行业科研专项经费项目(201202017)~~
【分类号】：R733.71

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