化疗联合HLA不全相合G-PBSC输注治疗恶性血液病的临床分析

发布时间：2018-03-09 23:20

本文选题：微移植　切入点：恶性血液病　出处：《兰州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的初步探讨化疗联合HLA不全相合G-PBSC输注(造血干细胞微移植)治疗恶性血液病的临床应用。方法回顾性分析2015年05月至2016年12月在本院接受造血干细胞微移植治疗的13例恶性血液病患者的临床及随访资料。13例患者在造血干细胞移植前均接受多次化疗;13例患者中,AML 7例(其中缓解5例,复发2例),ALL 3例(3例均为缓解),MAL 1例(复发),MDS-RAEB-1(中危-1)1例(缓解),非霍奇金淋巴瘤Ⅱ期B组1例(部分缓解)。根据患者病情,对13例患者行不同预处理方案化疗后,计划给予造血干细胞微移植3~4次,每次输注造血干细胞单个核细胞(MNC)数3.0×108/Kg,造血干细胞CD3+T数1.0×108/Kg。观察造血干细胞微移植后患者的缓解情况及生存时间,血象恢复时间,急、慢性移植物抗宿主病(GVHD)及其他不良反应发生情况。结果13例患者中,男8例(62%),女5例(38%),年龄9~75岁,中位年龄44岁;中危组8例,高危组5例;13例供者中,11例为血缘相关的HLA部分相合供者(92%),2例为血缘相关的HLA完全不相合供者(8%);13例患者共完成25次造血干细胞微移植,完成4次造血干细胞微移植1例,完成3次造血干细胞微移植3例,完成2次造血干细胞微移植3例,完成1次造血干细胞微移植6例。;至2017年4月1日随访截止,13例患者中,5例患者死亡,8例存活,其中2例复发。中危组8例,存活6例,其中复发1例;高危组5例,存活2例,其中复发1例,死亡病例中复发死亡4例,移植后因肺部感染死亡1例。造血干细胞微移植后,患者中性粒细胞恢复天数为5~14天,平均恢复天数为8天,血小板恢复时间为6~20天,平均恢复天数为11天。所有患者在微移植过程中均未出现急慢性GVHD、及其他不良反应。结论1.3例经多次化疗后复发的患者,给予造血干细胞微移植后达到缓解,造血干细胞微移植近期疗效较好有待进一步验证;2.本组病例选择上全为中高危组,患者依从性差,行造血干细胞微移植后疗效欠佳,复发率高;3.造血干细胞微移植在选择供者上不受限制,移植后血小板及中性粒细胞恢复较快,且无急慢性GVHD及其他不良反应发生;4.造血干细胞微移植的临床应用尚处于探索阶段,仍需多中心大样本的临床研究。
[Abstract]:Objective to explore the clinical application of chemotherapy combined with HLA incompatibility with G-PBSC infusion (hematopoietic stem cell microtransplantation) in the treatment of malignant hematological diseases. Methods from May 2015 to December 2016, we received hematopoietic stem cell microtransplantation in our hospital. Clinical and follow-up data of 13 patients with malignant hematologic diseases. 13 patients received multiple chemotherapy before hematopoietic stem cell transplantation. There were 3 cases of relapsing all and 3 cases were all in remission of mall (1 case of relapsing MDS-RAEB-1 (1 case of moderate risk) (1 case of remission, 1 case of stage B non-Hodgkin 's lymphoma) (partial remission). According to the condition of the patients, 13 cases were treated with different preconditioning regimen after chemotherapy. It was planned to give hematopoietic stem cell microtransplantation 3 times 4 times, the number of mononuclear cells of hematopoietic stem cells was 3.0 脳 10 8 / kg / kg each time, the CD3 T number of hematopoietic stem cells was 1.0 脳 10 8 / kg 路g. The remission and survival time of patients after hematopoietic stem cell microtransplantation were observed, and the recovery time of hematocrit was urgent. Results among the 13 patients with GVHD and other adverse reactions, there were 8 males and 5 females, aged 975 years, with a median age of 44 years, and 8 patients with moderate risk group (n = 8). In the high risk group, among 13 donors, 11 cases were blood related HLA partial matching donors, 2 cases were blood related HLA donors, 13 cases were complete 25 times of hematopoietic stem cell microtransplantation, 1 case was completed 4 times of hematopoietic stem cell microtransplantation, 2 cases were blood related HLA completely incompatible donors, 13 cases had complete hematopoietic stem cell microtransplantation, 1 case had completed 4 times of hematopoietic stem cell microtransplantation, 2 cases had complete hematopoietic stem cell microtransplantation. There were 3 cases of hematopoietic stem cell microtransplantation, 3 cases of 2 times of hematopoietic stem cell microtransplantation and 6 cases of 1 time hematopoietic stem cell microtransplantation. In the middle risk group, there were 8 cases of recurrence, 6 cases of survival, 5 cases of high risk group, 2 cases of survival, 1 case of recurrence, 4 cases of death, 5 cases of high risk group and 2 cases of survival. One case died of pulmonary infection after transplantation. After hematopoietic stem cell microtransplantation, neutrophil recovery was 5 ~ 14 days, average recovery time was 8 days and platelet recovery time was 6 ~ 20 days. The average recovery time was 11 days. No acute or chronic GVHD or other adverse reactions were found in all patients during microtransplantation. Conclusion 1.3 patients with recurrence after repeated chemotherapy received hematopoietic stem cell microtransplantation to achieve remission. The short term curative effect of hematopoietic stem cell microtransplantation needs further verification. 2. All the patients were selected as middle and high risk group, the patients' compliance was poor, and the curative effect after hematopoietic stem cell microtransplantation was poor. There is no restriction on the selection of donor for hematopoietic stem cell microtransplantation. After transplantation, platelet and neutrophils recover more quickly. The clinical application of hematopoietic stem cell microtransplantation (HSCT) is still in the exploratory stage, and a multi-center and large sample clinical study is still needed.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733

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