本文關(guān)鍵詞： 挽救性 二次移植 異基因造血干細(xì)胞移植 復(fù)發(fā)難治 惡性血液病　出處：《蘇州大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：觀察挽救性二次異基因造血干細(xì)胞移植治療16例移植后復(fù)發(fā)的惡性血液病的療效。方法：選取蘇州大學(xué)附屬第一醫(yī)院自2010年10月至2015年01月期間進(jìn)行挽救性二次異基因造血干細(xì)胞移植治療16例移植后復(fù)發(fā)的惡性血液病患者進(jìn)行療效分析。其中急性髓系白血病8例,急性淋巴細(xì)胞白血病2例,惡性淋巴瘤6例。首次移植情況：13例行自體外周血干細(xì)胞移植,2例行無關(guān)全相合移植,1例行同胞全相合移植,在移植后1～60個(gè)月復(fù)發(fā)。復(fù)發(fā)后采取的挽救性移植類型：單倍體半相合移植8例,同胞全相合移植3例,同胞8/10相合1例,無關(guān)供體移植4例。預(yù)處理方案為：含全身照射TBI聯(lián)合CTX方案或者改良BuCy。GVHD預(yù)防方案為環(huán)孢素A(CSA)、麥考酚酸酯(MMF)、抗胸腺細(xì)胞球蛋白(ATG)、及甲氨蝶呤(MTX)。結(jié)果：16例患者完全植入,移植后中性粒細(xì)胞(0.5×10E9/L)恢復(fù)平均時(shí)間為12(9～16)d,PLT(20×10E9/L)恢復(fù)平均時(shí)間為15(12～60)d。Ⅱ～Ⅳ度急性GVHD發(fā)生率為40.0%,3例發(fā)生慢性GVHD。隨訪觀察：9例存活,5例住院期間死亡,2例隨訪期間死亡,死亡原因分析：3例死于重癥感染,均為敗血癥合并肺部感染；3例死于急性GVHD:分別為腸道GVHD及肝臟合并腸道GVHD 1例死于慢性GVHD。無事件生存率29%,總體生存率(OS)為56%。結(jié)論：挽救性二次異基因造血干細(xì)胞移植可以改善難治復(fù)發(fā)性惡性血液病的總生存率和無事件生存率,為初次移植后復(fù)發(fā)患者的治療選擇之一。
[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，

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