异基因造血干细胞移植治疗急性髓系白血病以及骨髓增生异常综合征

发布时间：2018-04-22 03:33

  本文选题：造血干细胞移植 + 急性髓系白血病　； 参考：《中国医科大学学报》2017年01期

【摘要】：目的观察异基因造血干细胞移植治疗急性髓系白血病以及骨髓增生异常综合征的疗效和安全性。方法回顾性分析2011年4月至2016年4月在我院接受了异体造血干细胞移植的21例急性髓系白血病和8例骨髓增生异常综合征病例。其中,人类白细胞抗原(HLA)全相合异基因移植16例,单倍体相合异基因移植10例,同基因移植3例。预处理方案采用Bu Cy2±化疗,或全身照射(TBI)7.5~10 Gy联合环磷酰胺120 mg/kg±化疗。HLA全相合移植应用环孢素联合短程甲氨喋呤预防移植物抗宿主病(GVHD),单倍体相合移植采用兔抗人胸腺细胞球蛋白+环孢素+骁悉+甲氨喋呤+糖皮质激素,同基因移植无需GVHD预防。结果所有患者获得供者型造血重建。移植后100 d内死亡2例,随访中位时间23个月(1~60个月)。Ⅱ~Ⅳ度急性GVHD发生率为23.1%(6/26),其中Ⅲ/Ⅳ度2例;慢性GVHD 50%,其中轻度c GVHD 3例,中度6例,重度4例。移植相关死亡率13.8%(4/29),复发死亡率20.7%(6/29),2年总体生存率68.09%(95%CI:45.77%~82.78%),无病生存率60.22%(95%CI:38.19%~76.55%)。生存分析显示高危患者仍存在较高复发风险。结论 HLA全相合及单倍体相合异基因造血干细胞移植是安全、有效、可行的。严密监测高危患者,提前或及早干预是必要的,有利于进一步提高移植疗效。
[Abstract]:Objective to observe the efficacy and safety of allogeneic hematopoietic stem cell transplantation in the treatment of acute myeloid leukemia and myelodysplastic syndrome. Methods 21 cases of acute myeloid leukemia and 8 cases of myelodysplastic syndrome received allogeneic hematopoietic stem cell transplantation in our hospital from April 2011 to April 2016 were retrospectively analyzed. Among them, 16 cases were allogeneic transplantation, 10 cases were haploid allogeneic transplantation and 3 cases were syngeneic transplantation. Bu Cy2 卤chemotherapy was used for pretreatment. Or TBI 7.5 ~ 10 Gy combined with cyclophosphamide 120 mg/kg 卤chemotherapy.HLA homotransplantation with cyclosporine combined with short-course methotrexate to prevent graft-versus-host disease (GVHD), haploid matched transplantation with rabbit anti-human thymocyte globulin cyclosporine Mycophenolate mofetil methotrexate glucocorticoid, There is no need for GVHD to prevent homologous gene transplantation. Results all patients received donor hematopoietic reconstitution. Two patients died within 100 days after transplantation, and the median follow-up time was 23 months, ranging from 1 to 60 months. The incidence of acute GVHD of grade 鈪，

本文编号：1785434